Dialyze Direct in LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Carmel, IN
NPI 1770049017 · NPPES record last updated Mar 19, 2019
Key facts
- NPI
- 1770049017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- DIALYZE DIRECT IN LLC
- Practice address
- 13295 Illinois St Ste 210
Carmel, IN 46032-3021 - Phone
- (732) 806-9990
- NPI assigned
- Feb 12, 2019
- Organization subpart
- No
Authorized official
- Name
- Joshua Rothenberg
- Title
- Coo
- Phone
- (732) 806-9990
Affiliated clinicians 14
-
Raied Abdullah, M.D.
-
Gaurav Agarwal, MD
-
Mirza M Baig, M.D, FACP
-
John T Ducker, MD
-
Sherif M Elassal, M.D.
-
Sunil Kumar Gollapudi, M.D.
-
Swapna Joseph, MD
-
Muad Maya, MD
-
Amit Rai, MD
Medicare Care Compare: Dialysis facility
- Listed as
- Dialyze Direct Carmel, IN
- Ownership
- Profit
- Certified
- Jul 11, 2019
- Medicare certification status
- Active
- Chain
- Other
- Dialysis stations
- 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2285447 | Dialyze Direct in, LLC | Certificate of waiver | Jul 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191008000154 | IN | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 5597005983 | Practice locations: Carmel, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
13295 Illinois St Ste 210
Carmel, IN 46032-3021
Mailing address
3297 State Route 66
Neptune, NJ 07753-2762
Phone (732) 806-8362
Other providers in Carmel, IN
- Drake L. Dewitt
- Haley Dewitt
- Lindsay A. Dezelan
- Karena R Dhamecha
- Harimaya Poudel Dhungana
- Alanna Diamond
- Diana Clarke, LLC
- David Diaz
- Michael Ryan Dick
- Melissa M Dicke
All providers in Carmel, IN · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.