Active NPI
Brache Dialysis LLC
Doing business as Kennedy Boulevard Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Tampa, FL
National Provider Identifier
1871971556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- BRACHE DIALYSIS LLC
- Doing business as
- Kennedy Boulevard Dialysis
- Practice address
- 2205 W Kennedy Blvd
Tampa, FL 33606-1536 - Phone
- (813) 254-3638
- Fax
- (813) 254-3809
- NPI assigned
- May 13, 2015
- Last updated
- Aug 21, 2025
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
2205 W Kennedy Blvd
Tampa, FL 33606-1536
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017606800 | Medicaid | FL |
Other names 1
- Kennedy Boulevard Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150605002917 | FL | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 6002137700 | Practice locations: Tampa, FL |
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Kennedy Boulevard Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Feb 19, 2016
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 20
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2098874 | Kennedy Boulevard Dialysis | Certificate of waiver | Jul 15, 2027 |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Cerritos Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Cerritos, CA
- NPI 1255681011
Member Of
Locations
2205 W Kennedy Blvd
Tampa, FL 33606
Phone (813) 254-3638
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Adult Health Nurse Practitioner
- Tampa, FL
- NPI 1689393712
Affiliated clinicians 4
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": "1431475200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1755734400000",
"number": "1871971556",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2205 W KENNEDY BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336061536",
"telephone_number": "813-254-3638",
"fax_number": "813-254-3809"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRACHE DIALYSIS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-05-13",
"last_updated": "2025-08-21",
"certification_date": "2025-08-21",
"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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "017606800",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kennedy Boulevard Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kennedy Boulevard Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.