NPIMap

Organization Active NPI

Physicians Dialysis Acquisitions Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grand Haven, MI
National Provider Identifier
1699736116
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PHYSICIANS DIALYSIS ACQUISITIONS INC
Practice address
16964 Robbins Rd
Suite 203
Grand Haven, MI 49417-2796
Phone
(616) 847-2825
Fax
(616) 847-4428
NPI assigned
Apr 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

16964 Robbins Rd
Suite 203
Grand Haven, MI 49417-2796

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4514

Other identifiers 1

IdentifierTypeStateIssuer
4307276MedicaidMI

Other names 1

  • PDI Grand Haven Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021216000002 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769399666 Practice locations: Grand Haven, MI

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita PDI-Grand HavenCCN 232563
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Oct 1, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

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

National Provider Directory

National Provider Directory

Locations

16964 Robbins Rd
Ste 203
Grand Haven, MI 49417
Phone (616) 847-2825

16964 Robbins Rd
Ste 150
Grand Haven, MI 49417
Phone (616) 847-2825

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1143849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1699736116",
    "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",
            "telephone_number": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16964 ROBBINS RD",
            "address_2": "SUITE 203",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172796",
            "telephone_number": "616-847-2825",
            "fax_number": "616-847-4428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS DIALYSIS ACQUISITIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-01",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4307276",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDI Grand Haven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PDI Grand Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.