NPIMap

Organization Active NPI

Southwest Kidney Davita Dialysis Partners LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mesa, AZ
National Provider Identifier
1821344581
Registry record updated Apr 21, 2023
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
301 S Power Rd
Ste 104
Mesa, AZ 85206-5243
Phone
(480) 641-1193
Fax
(480) 807-3388
NPI assigned
Jul 31, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
John Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

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

Addresses

Primary practice location

301 S Power Rd
Ste 104
Mesa, AZ 85206-5243

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 341-6814

Other identifiers 1

IdentifierTypeStateIssuer
805318MedicaidAZ

Other names 1

  • Power Road Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121017000926 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 1456438423 Practice locations: Mesa, AZ

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Power Road Dialysis PDCCN 032638
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Feb 4, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

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
03D2046760Power Road Dialysis301 South Power Rd, Ste 104, Mesa, AZ 85206Certificate of waiverSep 10, 2026

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

Member of 1

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

Locations

301 S Power Rd
Mesa, AZ 85206

Practitioners & affiliated clinicians

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1821344581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6814",
            "fax_number": "800-293-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S POWER RD",
            "address_2": "STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852065243",
            "telephone_number": "480-641-1193",
            "fax_number": "480-807-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-31",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "805318",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Power Road Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Power Road Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.