Green Manor Dialysis Center LLC

Primary specialty

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

License

1059202R Issued in NY

Legal business name

GREEN MANOR DIALYSIS CENTER LLC

Doing business as

East Greenbush Dialysis

Practice address

583 Columbia Tpke
East Greenbush, NY 12061-1602

Phone

(518) 477-4370

Fax

(518) 477-4319

NPI assigned

Apr 21, 2016

Last updated

May 24, 2016By 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

Edward Fournier, RN,CNN

Title

Director of Dialysis Services

Phone

(518) 828-0717

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• East Greenbush Dialysis Doing business as

Listed as

DCI-East GreenbushCCN 332741

Overall star rating

1.0 of 5

Ownership

Non-profit

Certified

Sep 23, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Dialysis Clinic, Inc.

Dialysis stations

17

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vinny Anand, M.D.

  • Nephrology Physician
  • Hudson, NY
  • NPI 1336195510
  NPD (past)
• Vinita Gupta, M.D.

  • Pulmonary Disease Physician
  • Hudson, NY
  • NPI 1013963354
  NPD (past)

Affiliated clinicians 2

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

• Krishnakumar Hongalgi, MD

  • Nephrology Physician
  • Albany, NY
  • NPI 1962603225

  Dialysis facility

  Care Compare affiliation Name & address match
• Joseph M Roglieri, D.O.

  • Nephrology Physician
  • Troy, NY
  • NPI 1528021318

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1760836126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "583 COLUMBIA TPKE",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120611602",
            "telephone_number": "518-477-4370",
            "fax_number": "518-477-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 COLUMBIA TPKE",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120611602",
            "telephone_number": "518-477-4370",
            "fax_number": "518-477-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN MANOR DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "FOURNIER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR OF DIALYSIS SERVICES",
        "authorized_official_telephone_number": "518-828-0717",
        "authorized_official_credential": "RN,CNN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "1059202R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01687094",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Greenbush Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Godfrey, RN
• Christine Marie Goodemote, DDS, MS
• Brittany Gordon
• Michelle Gordon
• Jorianna Graham
• Saleema Grier, LPN
• Michelle Griffin
• Winter Michelle Guffey, D.C.
• Karen Haber, PT
• Ashley B Hable, MA, C-PED

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in East Greenbush, NY
• Providers in East Greenbush, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.