Dialysis Clinic Inc.

Primary specialty

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

Legal business name

DIALYSIS CLINIC INC.

Practice address

139 W Highway 64
MC Crory, AR 72101-8263

Phone

(870) 731-0220

Fax

(870) 731-0223

NPI assigned

Jun 10, 2008

Last updated

Oct 5, 2023By 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. Donvan Schultz

Title

President

Phone

(615) 327-3061

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Listed as

Dci - McCroryCCN 042583

Ownership

Non-profit

Certified

Sep 24, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Dialysis Clinic, Inc.

Dialysis stations

8

Tax ID family

Dialysis Clinic Inc238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Dialysis Clinic Inc

  dba Dialysis Clinic, Inc-North Little Rock

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • North Little Rock, AR
  • NPI 1821784182
  NPD tax ID
• Dialysis Clinic Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Little Rock, AR
  • NPI 1922346147
  NPD tax ID

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Affiliated clinicians 2

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

• Clinton Brough Edwards, MD

  • Nephrology Physician
  • Jonesboro, AR
  • NPI 1386611598

  Dialysis facility

  Care Compare affiliation Name & address match
• James Maxwell, MD

  • Nephrology Physician
  • Jonesboro, AR
  • NPI 1689714024

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1881854396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 64",
            "city": "MC CRORY",
            "state": "AR",
            "postal_code": "721018263",
            "telephone_number": "870-731-0220",
            "fax_number": "870-731-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 64",
            "city": "MC CRORY",
            "state": "AR",
            "postal_code": "721018263",
            "telephone_number": "870-731-0220",
            "fax_number": "870-731-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "174741134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in McCrory, AR
• Providers in McCrory, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.