Dva Renal Healthcare Inc

Primary specialty

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

License

ESRD006 Issued in NE

Legal business name

DVA RENAL HEALTHCARE INC

Doing business as

Omaha West Dialysis

Practice address

13014 W Dodge Rd
Omaha, NE 68154-2148

Phone

(402) 445-8950

Fax

(402) 445-8955

NPI assigned

Apr 3, 2006

Last updated

Aug 15, 2024By 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

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Omaha West Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Listed as

DaVita Omaha West DialysisCCN 282506

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 17, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

21

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

CLIA laboratory certificates

Tax ID family

Gambro Healthcare Escon173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

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

• Dva Renal Healthcare Inc

  dba Cornhusker Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bellevue, NE
  • NPI 1154383529
  NPD tax ID
• Dva Renal Healthcare Inc

  dba Sorensen Park Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Omaha, NE
  • NPI 1699737049
  NPD tax ID
• Dva Renal Healthcare Inc

  dba Omaha South Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Omaha, NE
  • NPI 1750343109
  NPD tax ID
• Dva Renal Healthcare, Inc

  dba Dodge County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fremont, NE
  • NPI 1962464388
  NPD tax ID

Affiliated clinicians 3

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

• Mohamad Ali Alhajhusain

  • Nephrology Physician
  • Omaha, NE
  • NPI 1770713257

  Dialysis facility

  Care Compare affiliation Name & address match
• Judd P Bauer, M.D.

  • Nephrology Physician
  • Omaha, NE
  • NPI 1982833554

  Dialysis facility

  Care Compare affiliation Name & address match
• Eric Keoni Magliulo, MD

  • Nephrology Physician
  • Omaha, NE
  • NPI 1336701689

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1902868367",
    "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": "13014 W DODGE RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542148",
            "telephone_number": "402-445-8950",
            "fax_number": "402-445-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "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": "NE",
            "license": "ESRD006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0546671",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omaha West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omaha West Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann Elizabeth Duvall
• Tanner Dux
• Dva Renal Healthcare Inc (Sorensen Park Dialysis)
• Dva Renal Healthcare Inc (Omaha South Dialysis)
• Dva Renal Healthcare Inc (Omaha Central Dialysis)
• Bethany Dvorachek
• Cydney Marie Dvorak
• Dawn Dvorak, CSW
• Dawson E Dvorak, M.A., LMHP
• Leslie Irene Dvorak, APRN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Omaha, NE
• Providers in Omaha, NE by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.