NPIMap

Organization Active NPI

Southwest Kidney Davita Dialysis Partners, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1801050604
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS, LLC
Practice address
3540 E Baseline Rd
Ste 110
Phoenix, AZ 85042-9628
Phone
(602) 431-2110
Fax
(602) 431-2153
NPI assigned
Jul 11, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Samuel T Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Member of 1

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

Affiliated clinicians 2

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Raven Dialysis CenterCCN 032625
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Apr 8, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
24

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1086907Raven Dialysis Center3540 East Baseline Road Suite 110, Phoenix, AZ 85042Certificate of waiverJul 21, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081003000231 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 1456438423 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory
Tax ID family
Southwest Kidney Davita Dialysis Partners LLC22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

NPPES NPI Registry

Primary practice location

3540 E Baseline Rd
Ste 110
Phoenix, AZ 85042-9628

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
425841MedicaidAZ

Other names 1

NPPES NPI Registry
  • Raven Dialysis Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 9, 2025.

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1801050604",
    "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": "3540 E BASELINE RD",
            "address_2": "STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850429628",
            "telephone_number": "602-431-2110",
            "fax_number": "602-431-2153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2025-05-09",
        "certification_date": "2025-04-29",
        "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": "425841",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raven Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Raven Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; 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.