Kidney Care Center of Winter Haven LLC

Primary specialty

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

Legal business name

KIDNEY CARE CENTER OF WINTER HAVEN LLC

Practice address

1107 3Rd St SW Ste 9
Winter Haven, FL 33880-3912

Phone

(305) 448-6261

NPI assigned

Oct 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Federico Dumenigo

Title

Ceo

Phone

(305) 448-6261

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Kidney Care Center of Winter HavenCCN 682709

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Feb 1, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

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

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cynthia M Cochran, LCSW

  • Clinical Social Worker
  • Winter Haven, FL
  • NPI 1740488873
  NPD
• Haldane W Porteous, M.D

  • Nephrology Physician
  • Winter Haven, FL
  • NPI 1134358716
  NPD (past)

Affiliated clinicians 1

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

• Haldane W Porteous, M.D

  • Nephrology Physician
  • Winter Haven, FL
  • NPI 1134358716

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1801496104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4960 SW 72ND AVE STE 208",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331555549",
            "telephone_number": "305-448-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 3RD ST SW STE 9",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803912",
            "telephone_number": "305-448-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE CENTER OF WINTER HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "DUMENIGO",
        "authorized_official_first_name": "FEDERICO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-448-6261",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin T. Barlow, PA
• Keyhole Surgery Center-Winter Haven LLC
• Farah Khan, MD
• Mehak Khan, OD
• Kristin Helen Kiddy, COTA/L
• Elizabeth Anne Kiel, RN
• Dana J. Killman, PA-C
• Jin Kim, D.C
• Angela Suk Kimbrell
• Kevin M Kindelan, PH.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.