Cleburne Dialysis LLC

Primary specialty

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

License

E2683 Issued in MD

Legal business name

CLEBURNE DIALYSIS LLC

Doing business as

Coral Hills Dialysis

Practice address

4797 Marlboro Pike
Capitol Heights, MD 20743-5213

Phone

(301) 420-1513

Fax

(301) 420-3912

NPI assigned

Nov 6, 2012

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

• Coral Hills Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

DaVita Coral Hills DialysisCCN 212683

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Feb 26, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

19

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.

• Total Renal Care Inc

  dba Cascade Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Locations

Affiliated clinicians 2

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

• Ashte Collins, M.D.

  • Nephrology Physician
  • Washington, DC
  • NPI 1295902625

  Dialysis facility

  Care Compare affiliation Name & address match
• Roopali Gupta, MD

  • Nephrology Physician
  • Washington, DC
  • NPI 1649478462

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1942554407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4214",
            "fax_number": "866-944-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4797 MARLBORO PIKE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207435213",
            "telephone_number": "301-420-1513",
            "fax_number": "301-420-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEBURNE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "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": "MD",
            "license": "E2683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "422880400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coral Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coral Hills Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Changingperspectives22 PLLC
• Bello Maigari Chew Tifang
• Brian Adimolisa Chigbue, MD
• Evelyn O Chimezie
• Cignet Urgent Care
• CN SBHC Walker Mill Ms
• Karen Ann Coates
• Billyjean Ann Cobrand
• Shanique Monera Cochran, PMHNP-BC
• Lester Antonio Cofield, PT, DPT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Capitol Heights, MD
• Providers in Capitol Heights, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.