Dialyze Direct Mo LLC

Primary specialty

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

Legal business name

DIALYZE DIRECT MO LLC

Practice address

1918 Innerbelt Business Center Dr
Saint Louis, MO 63114-5760

Phone

(732) 806-9990

Fax

(732) 806-9969

NPI assigned

Jan 8, 2017

Organization subpart

No

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

Authorized official

Name

Joshua Rothenberg

Title

Coo

Phone

(732) 806-9968

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

End-stage renal disease facility certification: CCN 262699

Legal name

DIALYZE DIRECT MO, LLC

Certification status

Active

Provider type (POS)

End-stage renal disease facility

Participating since

Aug 17, 2021

Last certification

Aug 17, 2021

Ownership / control type

For Profit

Facility address

1918 Innerbelt Business Center Dr
Saint Louis, MO 63114

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

{
    "created_epoch": "1483833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1952847477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 50TH ST",
            "address_2": "SUITE 401",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193769",
            "telephone_number": "732-806-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 INNERBELT BUSINESS CENTER DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631145760",
            "telephone_number": "732-806-9990",
            "fax_number": "732-806-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYZE DIRECT MO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-08",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "ROTHENBERG",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "732-806-9968"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.