Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Bowling Green, MO
NPI 1912930397 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1912930397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 4 Town Center Dr Ste F
Bowling Green, MO 63334 - Phone
- (573) 324-9886
- Fax
- (573) 324-9900
- NPI assigned
- Jul 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donovan Schultz
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 13
Affiliated clinicians 2
-
Prashanth Podaralla, M.D.
-
Karol Edward Rosner, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- Dialysis Clinics, Inc - Bowling Green
- Overall star rating
- ★★☆☆☆ 2.0 of 5
- Ownership
- Non-profit
- Certified
- Jan 23, 1989
- Medicare certification status
- Active
- Chain
- Dialysis Clinic, Inc.
- Dialysis stations
- 11
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0441167 | Dialysis Clinic Inc | Certificate of waiver | Jul 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100820000989 | MO | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Bowling Green, MO |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Locations
4 Town Center Dr
Ste F
Bowling Green, MO 63334
Phone (573) 324-9886
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
4 Town Center Dr Ste F
Bowling Green, MO 63334
Mailing address
4 Town Center Dr Ste F
Bowling Green, MO 63334-2805
Phone (573) 324-9886
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 501565162 | Medicaid | MO |
Other providers in Bowling Green, MO
- Country View Nursing Facility, Inc.
- Kaitlyn Dandridge
- Tori Alayne Davis
- Denise M. Harvey Dba Advanced Eyecare
- Dialysis Clinic Inc.
- Amanda Renee Dietrich
- John Thomas Dixon
- Doctor'S Health Group
- Elijah J Carroll
- Amy E Etsell
All providers in Bowling Green, MO · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.