Home Dialysis Specialty Center LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

D74250 Issued in MI

Legal business name

HOME DIALYSIS SPECIALTY CENTER LLC

Practice address

29001 Harper Ave
St CLR Shores, MI 48081-2711

Phone

(248) 642-5038

NPI assigned

Jun 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Faten Ayyoub, MDNPI 1881650760

Title

Partner

Phone

(248) 642-5038

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Home Dialysis Specialty CenterCCN 232691

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 20, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Greenfield Health Systems

Dialysis stations

1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Henry Ford Health System

  • Optometrist
  • Detroit, MI
  • NPI 1346324688

  Member Of

  NPD member

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Faten S Ayyoub, MD

  • Nephrology Physician
  • Saint Clair Shores, MI
  • NPI 1881650760
  NPD (past) Authorized official
• Rakesh Lattupalli, MD

  • Nephrology Physician
  • Rochester, MI
  • NPI 1841292158
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Faten S Ayyoub, MD

  • Nephrology Physician
  • Saint Clair Shores, MI
  • NPI 1881650760

  Dialysis facility

  Care Compare affiliation Name & address match
• Blessing N. Okoronkwo, M.D.

  • Nephrology Physician
  • Saint Clair Shores, MI
  • NPI 1720298136

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1699037028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30100 TELEGRAPH RD",
            "address_2": "SUITE 200",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254516",
            "telephone_number": "248-723-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29001 HARPER AVE",
            "city": "ST CLR SHORES",
            "state": "MI",
            "postal_code": "480812711",
            "telephone_number": "248-642-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME DIALYSIS SPECIALTY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "AYYOUB",
        "authorized_official_first_name": "FATEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "248-642-5038",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MI",
            "license": "D74250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Sky Physical Therapy
• Kelli M Vanoverbeke, NP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in St CLR Shores, MI
• Providers in St CLR Shores, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.