Platte Dialysis LLC

Primary specialty

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

Legal business name

PLATTE DIALYSIS LLC

Doing business as

Tahlequah Dialysis Center

Practice address

1373 E Boone St
Tahlequah, OK 74464-3364

Phone

(918) 431-0665

Fax

(918) 431-0623

NPI assigned

Oct 15, 2009

Last updated

Aug 16, 2023By 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 Wey

Title

Sr Director Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tahlequah Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

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

• Platte Dialysis LLC

  dba Redbird Smith Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sallisaw, OK
  • NPI 1205177870

  4789725524

  Same PAC ID
• Platte Dialysis LLC

  dba Muskogee Community Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Muskogee, OK
  • NPI 1598006041

  4789725524

  Same PAC ID
• Platte Dialysis LLC

  dba Stilwell Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Stilwell, OK
  • NPI 1972844884

  4789725524

  Same PAC ID

Listed as

DaVita Tahlequah Dialysis CenterCCN 372512

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jun 11, 1990

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

20

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

Platte Dialysis LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Platte Dialysis LLC

  dba Redbird Smith Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sallisaw, OK
  • NPI 1205177870
  NPD tax ID
• Platte Dialysis LLC

  dba Muskogee Community Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Muskogee, OK
  • NPI 1598006041
  NPD tax ID
• Platte Dialysis LLC

  dba Stilwell Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Stilwell, OK
  • NPI 1972844884
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Northeastern Health System

  • Land Ambulance
  • Tahlequah, OK
  • NPI 1871717819

  Member Of

  NPD member
• Renal Treatment Centers West Inc

  dba Clinton Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Clinton, OK
  • NPI 1730141078

  Member Of

  NPD member

Affiliated clinicians 2

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

• Tariq Yousef Mohammad Alyamani

  • Nephrology Physician
  • Tulsa, OK
  • NPI 1255941589

  Dialysis facility

  Care Compare affiliation Name & address match
• Bilal Aziz, MD

  • Nephrology Physician
  • Tahlequah, OK
  • NPI 1063725901

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1740515378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1373 E BOONE ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643364",
            "telephone_number": "918-431-0665",
            "fax_number": "918-431-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-15",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "SR DIRECTOR LICENSURE&CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200296340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tahlequah Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dalton Ryan Pickering, LPC CANDIDATE
• Victoria Hope Pierce, APRN
• Shannon Pinson, M.ED, CCC-SLP
• Elizabeth Raye Pittman, ATC
• Melissa Pitts Johnson, MS
• Janet Leslie Plaxico, PA
• Rhonda Pleasant
• Sean Wayne Poe, CRNA
• Todd K Pogue, DO
• Brandy Ponder, APRN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.