Revino Dialysis, LLC

Primary specialty

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

Legal business name

REVINO DIALYSIS, LLC

Doing business as

Fort Pierce Kidney Care

Practice address

2000 Hartman Rd Ste 2
Fort Pierce, FL 34947-4413

Phone

(772) 467-1117

Fax

(772) 595-9340

NPI assigned

Jul 14, 2022

Last updated

Apr 24, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

DAVITA INCAs reported in NPPES

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

Authorized official

Name

Samuel T. Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other names 1

• Fort Pierce Kidney Care Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

DaVita Fort Pierce Kidney CenterCCN 682745

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Oct 31, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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

CLIA laboratory certificates

Part of

Davita Inc

Member of 1

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

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member

Affiliated clinicians 3

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

• Jamie Andre, MD

  • Nephrology Physician
  • Fort Pierce, FL
  • NPI 1962665638

  Dialysis facility

  Care Compare affiliation Name & address match
• Mohammad Izhar, M.D.

  • Nephrology Physician
  • Fort Pierce, FL
  • NPI 1114178779

  Dialysis facility

  Care Compare affiliation Name & address match
• Samerah G Razuman, M.D.

  • Nephrology Physician
  • Fort Pierce, FL
  • NPI 1184672164

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1841924800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 HARTMAN RD STE 2",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349474413",
            "telephone_number": "772-467-1117",
            "fax_number": "772-595-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVINO DIALYSIS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA INC",
        "enumeration_date": "2022-07-14",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Pierce Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Pierce Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Restoration Ministries, Inc.
• Restoration Ministries, Inc. (Restoration House)
• Bryan T Reuther, PSYD
• Amy Humphreys Revels, APRN
• Ava Reverendo
• Andrew Knight Reyes
• Aurore Rezk, D.M.D.
• RG Ambulance Service II, LLC (All County Ambulance)
• RG Ambulance Service, Inc. (All County Ambulance)
• Joshua T Rhead

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fort Pierce, FL
• Providers in Fort Pierce, 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 Apr 24, 2024; 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.