Renal Treatment Centers-Illinois Inc

Primary specialty

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

License

300129 Issued in KY

Legal business name

RENAL TREATMENT CENTERS-ILLINOIS INC

Doing business as

Owensboro Dialysis Center

Practice address

1930 E Parrish Ave
Owensboro, KY 42303-1443

Phone

(270) 926-0120

Fax

(270) 691-9865

NPI assigned

Mar 27, 2006

Last updated

Apr 16, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• Owensboro Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Listed as

DaVita Owensboro Dialysis CenterCCN 182547

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Aug 3, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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

CLIA laboratory certificates

Tax ID family

Renal Treatment Centers - Illinois Inc85 organizations share this tax ID, including this one

Locations

Affiliated clinicians 5

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

• Dhiren M Haria, M.D.

  • Nephrology Physician
  • Owensboro, KY
  • NPI 1861434565

  Dialysis facility

  Care Compare affiliation Name & address match
• Hamza Arif, M.D.

  • Nephrology Physician
  • San Antonio, TX
  • NPI 1699161240

  Dialysis facility

  Care Compare affiliation Name & address match
• Hassaan Iftikhar, MD

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1962923177

  Dialysis facility

  Care Compare affiliation Name & address match
• Mohammad Bashar Mourad, M.D.

  • Nephrology Physician
  • Newburgh, IN
  • NPI 1093712952

  Dialysis facility

  Care Compare affiliation Name & address match
• Maryam Saleem, MD

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1518497791

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1730149170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 E PARRISH AVE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031443",
            "telephone_number": "270-926-0120",
            "fax_number": "270-691-9865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-09",
        "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": "KY",
            "license": "300129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39000674",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "=========",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owensboro Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Owensboro Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Reisz Pharmaceuticals Vital Care, Inc. (Reisz Pharmaceuticals Vital Care)
• Reisz Pharmaceuticals Vital Care, Inc. (Reisz Pharmaceuticals Vital Care)
• Reisz Pharmaceuticals Vital Care, Inc. (Reisz Pharmaceuticals Vital Care)
• Juanita Reisz, RPH
• Cecille Peralta Reloj, DNAP, CRNA, CRNA
• Emily Reusch, OCCUPATIONAL THERAPY
• Revive Life Ministries, Inc. (CrossPointe Wellness)
• Dawn Renee Reyes, RPH
• Holly M Reymolds, MSCCC/SLP
• Daniel Ada Reynolds, D.M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Owensboro, KY
• Providers in Owensboro, KY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.