NPIMap

Organization Active NPI

Dva Healthcare of Massachusetts Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Medford, MA
National Provider Identifier
1891754883
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
EQ1D Issued in MA
Legal business name
DVA HEALTHCARE OF MASSACHUSETTS INC
Practice address
10 Cabot Rd
Ste 103B
Medford, MA 02155-5275
Phone
(781) 306-9740
Fax
(781) 306-9745
NPI assigned
Mar 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X EQ1D MA Primary

Addresses

Primary practice location

10 Cabot Rd
Ste 103B
Medford, MA 02155-5275

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
110028113JMedicaidMA

Other names 1

  • Wellington Circle Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030425000019 MA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9830007202 Practice locations: Medford, MA

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Wellington Circle Dialysis CenterCCN 222542
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Mar 28, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
17

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 NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0926928Wellington Circle Dialysis Center10 Cabot Road Suite 103B, Medford, MA 02155Certificate of waiverApr 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare of Massachusetts Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 9

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": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1891754883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "10 CABOT RD",
            "address_2": "STE 103B",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021555275",
            "telephone_number": "781-306-9740",
            "fax_number": "781-306-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF MASSACHUSETTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "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": "MA",
            "license": "EQ1D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110028113J",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellington Circle Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellington Circle Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.