NPIMap

Organization Active NPI

Dialysis Clinic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Spartanburg, SC
National Provider Identifier
1699708073
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ERD-062 Issued in SC
Legal business name
DIALYSIS CLINIC, INC.
Practice address
105 Tradd St
Spartanburg, SC 29301-5085
Phone
(864) 574-8828
Fax
(864) 574-9629
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Mr. Donovan Schultz
Title
President
Phone
(615) 327-3061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ERD-062 SC Primary

Addresses

Primary practice location

105 Tradd St
Spartanburg, SC 29301-5085

Mailing address

105 Tradd St
Spartanburg, SC 29301-5085
Phone (864) 574-9629

Other identifiers 2

IdentifierTypeStateIssuer
4202560MedicaidNC
425605MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090414000537 SC Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Spartanburg, SC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dci West SpartanburgCCN 422560
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Mar 18, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
25

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0914602Dialysis Clinic, Inc - West105 Tradd Street, Spartanburg, SC 29301Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Elbert P Tuttle Jr MD238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

105 Tradd St
Spartanburg, SC 29301
Phone (864) 574-8828

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

Practitioners & affiliated clinicians

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1699708073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 TRADD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015085",
            "telephone_number": "864-574-9629",
            "fax_number": "864-574-9629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 TRADD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015085",
            "telephone_number": "864-574-8828",
            "fax_number": "864-574-9629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD-062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4202560",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425605",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.