Clark Dialysis LLC

Primary specialty

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

Legal business name

CLARK DIALYSIS LLC

Practice address

1127 West St
Ste 100
Annapolis, MD 21401-3615

Phone

(410) 626-6139

Fax

(410) 268-1294

NPI assigned

Feb 7, 2013

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 1

Other names 1

• Annapolis Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Member of 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775606400000",
    "number": "1740529932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 WEST ST",
            "address_2": "STE 100",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013615",
            "telephone_number": "410-626-6139",
            "fax_number": "410-268-1294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-07",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "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": "4228812 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Annapolis Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Annapolis Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary W Cima, MSW
• William John Cirksena Sr., M. D.
• City of Annapolis Finance Dept
• Claire S Duggal M D PA
• Mary R Clance, M.D., M.P.H.
• Alison Reece Clark, DPT
• Emma Clark
• Heather E Clark, LPC, LCPC
• M. Justine Clark, DO
• Michael B Clark, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Annapolis, MD
• Providers in Annapolis, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.