Ellicott City Dialysis Center LLC

Primary specialty

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

Legal business name

ELLICOTT CITY DIALYSIS CENTER LLC

Practice address

3419 Plum Tree Dr
Suites 103-106
Ellicott City, MD 21042-3805

Phone

(410) 750-8426

Fax

(410) 750-8428

NPI assigned

Apr 4, 2007

Last updated

Mar 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jason Boucher

Title

Cfo

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

Listed as

DaVita Ellicott City DialysisCCN 212560

Overall star rating

4.0 of 5

Ownership

Profit

Certified

May 25, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

18

Locations

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.

• Mary A Pieprzak, M.D.

  • Nephrology Physician
  • Columbia, MD
  • NPI 1326046202
  NPD (past)

Affiliated clinicians 3

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

• Reshma Joseph Kariyil, MD

  • Nephrology Physician
  • Owings Mills, MD
  • NPI 1487150918

  Dialysis facility

  Care Compare affiliation Name & address match
• Jia Liu, M.D.

  • Nephrology Physician
  • Columbia, MD
  • NPI 1043282544

  Dialysis facility

  Care Compare affiliation Name & address match
• Misha Varma, MD

  • Nephrology Physician
  • Columbia, MD
  • NPI 1346701513

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553212800000",
    "number": "1881716785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 PLUM TREE DR",
            "address_2": "SUITES 103-106",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423805",
            "telephone_number": "410-750-8426",
            "fax_number": "410-750-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3419 PLUM TREE DR",
            "address_2": "SUITES 103-106",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423805",
            "telephone_number": "410-750-8426",
            "fax_number": "410-750-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT CITY DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2019-03-22",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "978-922-3080",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412495200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Kiser Elkins, LCSW-C
• Ellicott Cir Acupuncture LLC
• Ellicott City Aesthetics LLC
• Ellicott City Ambulatory Surgery Center, LLLP (Ellicott City Ambulatory Surgery Center)
• Ellicott City Anesthesia Associates, LLC
• Ellicott City Eye Care, Inc.
• Ellicott City Health LLC
• Ellicott City Nursing and Rehab Center LLC (Ellicott City Healthcare Center)
• Ellicott City Pediatric Assoc
• Ellicott City Pediatric Associates, PA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.