Woodmere Dialysis,LLC

Primary specialty

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

Legal business name

WOODMERE DIALYSIS,LLC

Practice address

801 Co Op City Blvd
Bronx, NY 10475-1603

Phone

(718) 239-6444

NPI assigned

Oct 23, 2019

Organization subpart

No

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

Authorized official

Name

Miles Davis

Title

Director

Phone

(800) 975-5201

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bay Bark Dalysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Woodmere Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southampton, NY
  • NPI 1861933368

  9335152917

  Same PAC ID
• Woodmere Dialysis,LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Woodmere, NY
  • NPI 1750308748

  9335152917

  Same PAC ID

Listed as

Bay Park Dialysis CenterCCN 332806

Ownership

Profit

Certified

Feb 20, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

Tax ID family

Bay Bark Dalysis Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Woodmere Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southampton, NY
  • NPI 1861933368
  NPD tax ID

Affiliated clinicians 1

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

• Suman M Reddy, MD

  • Nephrology Physician
  • Bronx, NY
  • NPI 1447363247

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1699318675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 CO OP CITY BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751603",
            "telephone_number": "718-239-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 CO OP CITY BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751603",
            "telephone_number": "718-239-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMERE DIALYSIS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-23",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MILES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "800-975-5201"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPERATING CERTIFICATE",
            "identifier": "2950210R",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Bark Dalysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Woodlawn Neurological Associates
• Carolyn Melissa Woodley, PHARMD
• Monique Louisa Woodley, RN, IBCLC
• Myron Woodley, LMSW
• Sharon Diann Woodley, MA
• Kehli Woodruff
• Denyse Woods, PSY.D.
• Eric Woods, M.D.
• Ericka Renee Woods, B.S.
• Kim Benjamin Woods, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Bronx, NY
• Providers in Bronx, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.