Goodale Dialysis LLC

Primary specialty

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

Legal business name

GOODALE DIALYSIS LLC

Practice address

2302 Chester Blvd
Richmond, IN 47374-1221

Phone

(765) 935-5128

Fax

(765) 935-5749

NPI assigned

Aug 20, 2015

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

• Whitewater Valley Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

DaVita Whitewater Valley DialysisCCN 152680

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Apr 4, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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 2

Organizations this organization is a member of, according to the National Provider Directory.

• Reid Hospital & Health Care Services, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Richmond, IN
  • NPI 1437188786

  Member Of

  NPD member
• Total Renal Care Inc

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

  Member Of

  NPD member

Affiliated clinicians 3

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

• Jacques Raymond Daoud, M.D

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1548405285

  Dialysis facility

  Care Compare affiliation Name & address match
• Sherif M Elassal, M.D.

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1184625774

  Dialysis facility

  Care Compare affiliation Name & address match
• Louis George Seele, MD

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1992838973

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1962878231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 CHESTER BLVD",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473741221",
            "telephone_number": "765-935-5128",
            "fax_number": "765-935-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODALE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-27",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300009861",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitewater Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whitewater Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Goens, RBT
• Brian Ray Goggins, M.D.
• Betty Goins
• Golden Hour Homecare LLC
• Amelia Ann Golden, FNP- C
• Hannah Kayann Goodrich
• Jeffery Lee Gore, D.D.S.
• Vijay Gottipati, MD
• Steven Grant, PHARMD, RPH
• Connie Gray, RBT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Richmond, IN
• Providers in Richmond, IN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.