Heideck Dialysis LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Roscommon, MI
NPI 1831512003 · NPPES record last updated Dec 21, 2022
Key facts
- NPI
- 1831512003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- HEIDECK DIALYSIS LLC
- Practice address
- 10450 N Roscommon Rd
Roscommon, MI 48653-9296 - Phone
- (989) 275-0362
- Fax
- (989) 275-0409
- NPI assigned
- Jan 24, 2014
- Organization subpart
- No
Authorized official
- Name
- John D Winstel
- Title
- Chief Accounting Officer
- Phone
- (253) 733-4501
Member of 1
Affiliated clinicians 1
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Roscommon Dialysis
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Profit
- Certified
- Nov 10, 2015
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 13
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2080486 | Roscommon Dialysis | Certificate of waiver | Jul 8, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160128000098 | MI | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 2567694920 | Practice locations: Roscommon, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
10450 N Roscommon Rd
Roscommon, MI 48653-9296
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4514
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831512003 | Medicaid | MI |
Other names
- Roscommon Dialysis
Other providers in Roscommon, MI
- Heather Goodrow
- Nicole Lynn Grace
- Angela Griffis
- Andrew Gronski
- Steven Carl Haertel
- Higgins Lake Dental
- Higgins Township Roscommon County Mich
- Hilltop Michigan Healthcare, LLC
- Tami Hough
- Amanda Howe
All providers in Roscommon, MI · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.