NPIMap

Organization Active NPI

Independent Dialysis Foundation, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Glen Burnie, MD
National Provider Identifier
1942218797
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2544R Issued in MD
Legal business name
INDEPENDENT DIALYSIS FOUNDATION, INC
Practice address
804 Landmark Dr
Suite 112
Glen Burnie, MD 21061-4486
Phone
(410) 468-0900
Fax
(410) 468-0911
NPI assigned
Aug 4, 2006
Last updated
Jul 16, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
INDEPENDENT DIALYSIS FOUNDATION, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Authorized official

Name
Zeke Ayele
Title
Director of Information Systems
Phone
(410) 468-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2544R MD Primary

Addresses

Primary practice location

804 Landmark Dr
Suite 112
Glen Burnie, MD 21061-4486

Mailing address

840 Hollins St
Baltimore, MD 21201-1024
Phone (410) 468-0900

Other identifiers 8

IdentifierTypeStateIssuer
0005759000MedicaidWV
590077-01OtherMDCAREFIRST
21506OtherMDJAI MEDICAL
215143OtherMDMDIPA
PS4OtherMDFEP
0704865003OtherMDCIGNA
0125608OtherMDAETNA
01689292MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080117000546 MD Part A Provider - End-Stage Renal Disease Facility (ESRD) 7719958503 Practice locations: Glen Burnie, MD

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Idf - Arundel CenterCCN 212544
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Dec 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Independent Dialysis Foundation (IDF)
Dialysis stations
24

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Independent Dialysis Foundation Inc7 organizations share this tax ID, including this one
Part of
Independent Dialysis Foundation Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

804 Landmark Dr
Ste 110
Glen Burnie, MD 21061
Phone (410) 768-5722

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1942218797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 HOLLINS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011024",
            "telephone_number": "410-468-0900",
            "fax_number": "410-468-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 LANDMARK DR",
            "address_2": "SUITE 112",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614486",
            "telephone_number": "410-468-0900",
            "fax_number": "410-468-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT DIALYSIS FOUNDATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDEPENDENT DIALYSIS FOUNDATION, INC",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "AYELE",
        "authorized_official_first_name": "ZEKE",
        "authorized_official_title_or_position": "DIRECTOR OF INFORMATION SYSTEMS",
        "authorized_official_telephone_number": "410-468-0900"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2544R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005759000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "590077-01",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAI MEDICAL",
            "identifier": "21506",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA",
            "identifier": "215143",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEP",
            "identifier": "PS4",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0704865003",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0125608",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01689292",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.