NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Shelton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shelton, CT
National Provider Identifier
1891761565
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
0244 Issued in CT
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Shelton Dialysis
Practice address
750 Bridgeport Ave
Shelton, CT 06484-4734
Phone
(203) 925-9520
Fax
(203) 925-9536
NPI assigned
Feb 23, 2006
Last updated
Dec 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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 0244 CT Primary

Addresses

Primary practice location

750 Bridgeport Ave
Shelton, CT 06484-4734

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
004142650MedicaidCT

Other names 1

  • Shelton Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030220000035 CT Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Shelton, CT

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Shelton DialysisCCN 072510
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Mar 31, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
22

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
07D0901635Shelton Dialysis750 Bridgeport Avenue, Shelton, CT 06484Certificate of waiverMay 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 3

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

Member of 1

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

Locations

750 Bridgeport Ave
Shelton, CT 06484
Phone (203) 925-9520

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1891761565",
    "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": "750 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844734",
            "telephone_number": "203-925-9520",
            "fax_number": "203-925-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "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": "CT",
            "license": "0244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004142650",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shelton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; 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.