Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Cincinnati, OH
NPI 1851329403 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1851329403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 0063DC (OH)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 499 E McMillan St
Cincinnati, OH 45206-1938 - Phone
- (513) 281-0091
- Fax
- (513) 221-3425
- NPI assigned
- Jun 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 6
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0345891 | Dialysis Clinics Inc | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100317000676 | OH | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Cincinnati, OH |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 0063DC | OH | Yes |
Addresses
Primary practice location
499 E McMillan St
Cincinnati, OH 45206-1938
Mailing address
499 E McMillan St
Cincinnati, OH 45206-1938
Phone (513) 281-0091
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100002590 | Medicaid | IN | |
| 0345157 | Medicaid | OH | |
| 39954003 | Medicaid | KY |
Other providers in Cincinnati, OH
- Dialysis Access Center of Cincinnati, Inc.
- Dialysis Clinic Inc
- Dialysis Clinic Inc.
- Dialysis Clinic Inc.
- Dialysis Clinic Inc.
- Johnnie L Diamante
- Diamond Home Care Experience LLC
- Diamond Laced Medical Wigs
- Paul L Diamond
- Samba Diaw
All providers in Cincinnati, OH · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2023. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.