NPIMap

Organization Active NPI

Kidney Life, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Newark, NJ
National Provider Identifier
1821646035
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
KIDNEY LIFE, LLC
Doing business as
Newark Mt Pleasant Dialysis
Practice address
262 Broad St
Newark, NJ 07104-3809
Phone
(973) 268-7184
Fax
(973) 268-2802
NPI assigned
Aug 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

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

Addresses

Primary practice location

262 Broad St
Newark, NJ 07104-3809

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0980544MedicaidNJ

Other names 1

  • Newark Mt Pleasant Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230331001319 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769665207 Practice locations: Newark, NJ

Other NPIs with the same Medicare PAC ID 23

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

View all 23

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Newark Mt PleasantCCN 312698
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Mar 23, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
21

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
31D2173377Newark Mt Pleasant Dialysis262 Broad St, Newark, NJ 07104Certificate of waiverOct 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Kidney Life LLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Member of 2

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

Locations

262 Broad St
Newark, NJ 07104
Phone (973) 268-7184

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1567123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1821646035",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 BROAD ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071043809",
            "telephone_number": "973-268-7184",
            "fax_number": "973-268-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-30",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0980544",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newark Mt Pleasant Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newark Mt Pleasant Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.