Fort Smith Regional Dialysis Center, LLC

Primary specialty

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

Legal business name

FORT SMITH REGIONAL DIALYSIS CENTER, LLC

Practice address

1200 Central St
Poteau, OK 74953-2320

Phone

(918) 647-9373

NPI assigned

May 23, 2005

Organization subpart

No

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

Authorized official

Name

Laura Palmer

Title

Executive Director

Phone

(479) 755-6700

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Poteau Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Fort Smith Regional Dialysis Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Smith, AR
  • NPI 1871596916

  9133192891

  Same PAC ID
• Fort Smith Regional Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Van Buren, AR
  • NPI 1760092597

  9133192891

  Same PAC ID

Listed as

Poteau Dialysis CtrCCN 372559

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jun 5, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

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

CLIA laboratory certificates

Member of 1

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

• Cooper Clinic, PA

  • Family Medicine Physician
  • Paris, AR
  • NPI 1790706497

  Member Of

  NPD member

Affiliated clinicians 2

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

• James Lewis Bruton, MD

  • Nephrology Physician
  • Fort Smith, AR
  • NPI 1245228055

  Dialysis facility

  Care Compare affiliation Name & address match
• Charles Moussallem, M.D

  • Nephrology Physician
  • Fort Smith, AR
  • NPI 1023318334

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1912900044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 BROOKEN HILL DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729088611",
            "telephone_number": "479-755-6700",
            "fax_number": "479-755-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CENTRAL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749532320",
            "telephone_number": "918-647-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SMITH REGIONAL DIALYSIS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-755-6700"
    },
    "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": "100707620A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146670734",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN'S",
            "identifier": "900522191",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poteau Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Farley
• Amy Cathleen Ferguson, MOT, OTR/L
• Charles Fields
• Jason Floyd
• Mallary Flurry
• Rhonda Sue Fox
• Michele Fredrickson
• Cecilia G Freeman, BSW
• Gary Wayne Furr Jr.
• Brenda J. Garland, PSRS

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Poteau, OK
• Providers in Poteau, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.