Fort Smith Regional Dialysis Center, LLC

Primary specialty

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

Legal business name

FORT SMITH REGIONAL DIALYSIS CENTER, LLC

Practice address

256 Northridge Drive E
Van Buren, AR 72956

Phone

(479) 755-6754

Fax

(479) 755-6849

NPI assigned

Aug 6, 2020

Organization subpart

Yes

Parent organization

FORT SMITH REGIONAL DIALYSIS CENTER, LLCAs reported in NPPES

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

Authorized official

Name

Laura Anne Palmer

Title

Executive Director

Phone

(479) 755-6750

Specialties & licenses 1

Addresses

Other names 1

• Van Buren Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Fort Smith Regional Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Smith, AR
  • NPI 1871596916

  9133192891

  Same PAC ID
• Fort Smith Regional Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Poteau, OK
  • NPI 1912900044

  9133192891

  Same PAC ID

Listed as

Van Buren Dialysis CenterCCN 042600

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Aug 10, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

26

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

CLIA laboratory certificates

Part of

Fort Smith Regional Dia

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David R Nichols, MD

  • Pulmonary Disease Physician
  • Jonesboro, AR
  • NPI 1528055449
  NPD (past)

Affiliated clinicians 4

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

• James Lewis Bruton, MD

  • Nephrology Physician
  • Fort Smith, AR
  • NPI 1245228055

  Dialysis facility

  Care Compare affiliation Name & address match
• Charles Moussallem, M.D

  • Nephrology Physician
  • Fort Smith, AR
  • NPI 1023318334

  Dialysis facility

  Care Compare affiliation Name & address match
• Dumitru Rotaru, M.D.

  • Nephrology Physician
  • Fort Smith, AR
  • NPI 1407042252

  Dialysis facility

  Care Compare affiliation Name & address match
• Muhammad Zatmar Khan

  • Nephrology Physician
  • Laurel, MS
  • NPI 1740767961

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1760092597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 181210",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729181210",
            "telephone_number": "479-755-6754",
            "fax_number": "479-755-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 NORTHRIDGE DRIVE E",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "72956",
            "telephone_number": "479-755-6754",
            "fax_number": "479-755-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SMITH REGIONAL DIALYSIS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORT SMITH REGIONAL DIALYSIS CENTER, LLC",
        "enumeration_date": "2020-08-06",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-755-6750"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Buren Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Francis Followell, O.D.
• Ashley Brooke Folsom
• Christina Fontaine, COTA/L
• Fort Smith Hma PBC Management, LLC
• Fort Smith Hma PBC Management, LLC
• Cassandra Francis
• Tiffany Ruby Frank
• Cassie Franklin
• Richard J Franzmeier, DDS
• Allison Frazier

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Van Buren, AR
• Providers in Van Buren, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.