Itasca Dialysis LLC

Primary specialty

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

Legal business name

ITASCA DIALYSIS LLC

Doing business as

Brighton Park Dialysis

Practice address

4737 S California Ave
Chicago, IL 60632-2015

Phone

(773) 523-2441

Fax

(773) 523-2468

NPI assigned

Nov 8, 2017

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other names 1

• Brighton Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

DaVita Brighton Park DialysisCCN 142860

Overall star rating

5.0 of 5

Ownership

Profit

Certified

Jul 17, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

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.

• Total Renal Care Inc

  dba Edgewater Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockfrd, IL
  • NPI 1154997591

  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.

• Rita L McGill

  • Nephrology Physician
  • Chicago, IL
  • NPI 1700887296
  NPD (past)
• Bharathi Reddy

  • Nephrology Physician
  • Chicago, IL
  • NPI 1073676599
  NPD (past)

Affiliated clinicians 2

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

• Ogbonnaya E Aneziokoro, MD

  • Nephrology Physician
  • Chicago, IL
  • NPI 1104831668

  Dialysis facility

  Care Compare affiliation Name & address match
• Bharathi Reddy

  • Nephrology Physician
  • Chicago, IL
  • NPI 1073676599

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1699288092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4737 S CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322015",
            "telephone_number": "773-523-2441",
            "fax_number": "773-523-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITASCA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brighton Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sina Ith, PHARMD
• Marya Itkina, LMT
• Gail S Itokazu, PHARMD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.