NPIMap

Organization Active NPI

Fort Smith Regional Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Smith, AR
National Provider Identifier
1871596916
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
FORT SMITH REGIONAL DIALYSIS CENTER LLC
Practice address
2201 Brooken Hill Dr
Fort Smith, AR 72908-8611
Phone
(479) 755-6700
Fax
(479) 755-6704
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Authorized official

Name
Laura Palmer
Title
Executive Director
Phone
(479) 755-6750

Specialties & licenses 1

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

Addresses

Primary practice location

2201 Brooken Hill Dr
Fort Smith, AR 72908-8611

Mailing address

2201 Brooken Hill Dr
Fort Smith, AR 72908-8611
Phone (479) 755-6700

Other identifiers 4

IdentifierTypeStateIssuer
134859734MedicaidAR
140066002MedicaidAR
12501OtherARAR BLUE CROSS
100728340AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130214000321 AR Part A Provider - End-Stage Renal Disease Facility (ESRD) 9133192891 Practice locations: Fort Smith, AR

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Ft Smith Regional Dialysis CtrCCN 042501
Overall star rating
1.0 of 5
Ownership
Profit
Certified
May 11, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
55

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Member of 1

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

Locations

256 Northridge Dr E
Van Buren, AR 72956
Phone (479) 262-5700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 6

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": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1871596916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 BROOKEN HILL DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729088611",
            "telephone_number": "479-755-6700",
            "fax_number": "479-755-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 BROOKEN HILL DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729088611",
            "telephone_number": "479-755-6700",
            "fax_number": "479-755-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SMITH REGIONAL DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-755-6750"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134859734",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140066002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BLUE CROSS",
            "identifier": "12501",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.