St Lukes Dialysis LLC

Primary specialty

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

License

0294DC Issued in OH

Legal business name

ST LUKES DIALYSIS LLC

Practice address

12800 Shaker Blvd
Ste 1
Cleveland, OH 44120-2000

Phone

(216) 491-4867

Fax

(216) 491-4925

NPI assigned

Jan 11, 2007

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

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shaker Square Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

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

CLIA laboratory certificates

Member of 1

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

• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bourbonnais, IL
  • NPI 1073675138

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1780734012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 SHAKER BLVD",
            "address_2": "STE 1",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441202000",
            "telephone_number": "216-491-4867",
            "fax_number": "216-491-4925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "OH",
            "license": "0294DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2823207",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shaker Square Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shaker Square Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Priscella St Clair, RN
• Erin Lee St Denis, OTR L
• Maepearl St George, PA-C
• Kayla Breann St John, LSW, MSW
• St Judes Medical Clinic
• St Vincent Charity Hospital
• St Vincent Charity Medical Center
• St Vincent Charity Medical Center
• St Vincent Charity Medical Center
• St Vincent Charity Medical Center

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Cleveland, OH
• Providers in Cleveland, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.