NPIMap

Organization Active NPI

Dialysis Clinic Inc.

Doing business as DCI Lake Home Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Osage Beach, MO
National Provider Identifier
1952748097
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DIALYSIS CLINIC INC.
Doing business as
DCI Lake Home Dialysis
Practice address
3797 Osage Beach Pkwy Ste B4
Osage Beach, MO 65065-2186
Phone
(573) 302-0375
Fax
(573) 302-0383
NPI assigned
May 30, 2013
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Mr. Donovan Schultz II
Title
President
Phone
(615) 327-3061

Specialties & licenses 1

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

Addresses

Primary practice location

3797 Osage Beach Pkwy Ste B4
Osage Beach, MO 65065-2186

Mailing address

1633 Church St Ste 500
Nashville, TN 37203-2948
Phone (615) 342-0552

Other names 1

  • DCI Lake Home Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130723001034 MO Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Osage Beach, MO

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DCI Lake Home DialysisCCN 262661
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Nov 20, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2079334Dci Lake Home Dialysis3797 Osage Beach Parkway, Suite B4, Osage Beach, MO 65065Certificate of waiverJun 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Margaret Dillard MD238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rancho Dialysis ClinicSacramento, CA, CCN 552519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 24, 2003
Dec 24, 2003

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": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1952748097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 CHURCH ST STE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032948",
            "telephone_number": "615-342-0552",
            "fax_number": "615-341-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3797 OSAGE BEACH PKWY STE B4",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652186",
            "telephone_number": "573-302-0375",
            "fax_number": "573-302-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-327-3061",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DCI Lake Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DCI Lake Home Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.