Ogano Dialysis LLC

Primary specialty

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

Legal business name

OGANO DIALYSIS LLC

Doing business as

Chantilly Dialysis

Practice address

14225 Sullyfield Cir Ste a
Chantilly, VA 20151-1688

Phone

(703) 263-0215

Fax

(703) 378-7692

NPI assigned

May 24, 2017

Last updated

Jan 11, 2024By 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

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chantilly Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Listed as

DaVita Chantilly DialysisCCN 492722

Overall star rating

5.0 of 5

Ownership

Profit

Certified

Aug 20, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

17

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 Mid Atlantic Inc

  dba Grovepark Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jackson, GA
  • NPI 1558330522

  Member Of

  NPD member

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.

• Nicole Marshall, LCSW

  • Clinical Social Worker
  • Chantilly, VA
  • NPI 1134812910
  NPD
• Ahmadshah Mirkhel, M.D.

  • Nephrology Physician
  • Fairfax, VA
  • NPI 1790729317
  NPD (past)

Affiliated clinicians 3

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

• Behnaz Haddadi-Sahneh, M.D.

  • Nephrology Physician
  • Fairfax, VA
  • NPI 1306207238

  Dialysis facility

  Care Compare affiliation Name & address match
• Anup Manoharan, M.D.

  • Nephrology Physician
  • Fairfax, VA
  • NPI 1700954252

  Dialysis facility

  Care Compare affiliation Name & address match
• Ahmadshah Mirkhel, M.D.

  • Nephrology Physician
  • Fairfax, VA
  • NPI 1790729317

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1790213593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4214",
            "fax_number": "866-944-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14225 SULLYFIELD CIR STE A",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511688",
            "telephone_number": "703-263-0215",
            "fax_number": "703-378-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OGANO DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-24",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-10",
        "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": "1790213593",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chantilly Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chantilly Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Chantilly, VA
• Providers in Chantilly, VA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Virginia

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