Dialysis Management Group LLC

Primary specialty

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

Legal business name

DIALYSIS MANAGEMENT GROUP LLC

Doing business as

Porcupine Dialysis Center

Practice address

HCR 49
Porcupine, SD 57772-0000

Phone

(605) 718-0392

NPI assigned

Oct 15, 2010

Last updated

Nov 22, 2013By 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

Mr. Allen Rada

Title

President

Phone

(605) 390-0910

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Porcupine Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

• Black Hills Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pine Ridge, SD
  • NPI 1710087713

  Member Of

  NPD member
• Blackhills Dialysis, L.L.C.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eagle Butte, SD
  • NPI 1316147440

  Member Of

  NPD member
• Dialysis Management Group LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Porcupine, SD
  • NPI 1033219035

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anthony S Diehl, MD

  • Obstetrics & Gynecology Physician
  • Rapid City, SD
  • NPI 1053342691
  NPD (past)
• Beth A Iverson, CNP

  • Nurse Practitioner
  • Rapid City, SD
  • NPI 1043264146
  NPD (past)

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385078400000",
    "number": "1922318666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HCR 49 BOX 82C",
            "city": "PORCUPINE",
            "state": "SD",
            "postal_code": "577720000",
            "telephone_number": "605-718-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HCR 49",
            "city": "PORCUPINE",
            "state": "SD",
            "postal_code": "577720000",
            "telephone_number": "605-718-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-15",
        "last_updated": "2013-11-22",
        "status": "A",
        "authorized_official_last_name": "RADA",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-390-0910",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5400390",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Porcupine Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chanku Waste Dental LLC
• Dialysis Management Group LLC
• Alicia Claire Mousseau, PH.D.
• Pine Ridge Indian Health Service Hospital
• Tadd Evan Sharp-Bowman

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Porcupine, SD
• Providers in Porcupine, SD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.