Lory Dialysis LLC

Primary specialty

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

Legal business name

LORY DIALYSIS LLC

Practice address

65 S Terrace Ave
Newark, OH 43055-1355

Phone

(740) 522-2955

Fax

(740) 522-2975

NPI assigned

Jul 18, 2011

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Premiere Kidney Center of Newark Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

DaVita Premiere Kidney Center of NewarkCCN 362644

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 30, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

21

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.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 3

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

• Frank Boateng, M.D

  • Nephrology Physician
  • Newark, OH
  • NPI 1609025527

  Dialysis facility

  Care Compare affiliation Name & address match
• Stephanie E. Ladson-Wofford, M.D.

  • Nephrology Physician
  • Westerville, OH
  • NPI 1689673329

  Dialysis facility

  Care Compare affiliation Name & address match
• Hintsa Tewoldemedin, MD

  • Nephrology Physician
  • Newark, OH
  • NPI 1033168554

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1831487313",
    "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": "615-238-3051",
            "fax_number": "800-246-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 S TERRACE AVE",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551355",
            "telephone_number": "740-522-2955",
            "fax_number": "740-522-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "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": "0057201",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premiere Kidney Center of Newark",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premiere Kidney Center of Newark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Long, RN
• Loretta Long, NMW
• Morgan Elaine Long, PHARMD
• Scottie Long, COTA
• Ryan Wesley Longstreth, M.D.
• Nicole Daniele Loudermilk
• Stefanie Anne Loughman
• Melissa Marie Louk, CDCA, QBHS
• Amber Love
• Tricia M Love, LPCC-S

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Newark, OH
• Providers in Newark, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

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