NPIMap

Organization Active NPI

Dialysis Clinic Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Somerville, MA
National Provider Identifier
1972536357
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E90R Issued in MA
Legal business name
DIALYSIS CLINIC INC.
Practice address
643 Broadway
Somerville, MA 02145-2528
Phone
(617) 956-6389
Fax
(617) 616-3699
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E90R MA Primary

Addresses

Primary practice location

643 Broadway
Somerville, MA 02145-2528

Mailing address

643 Broadway
Somerville, MA 02145-2528
Phone (617) 616-3600

Other identifiers 1

IdentifierTypeStateIssuer
1312286MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100507000410 MA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Somerville, MA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DCI Ball SquareCCN 222549
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Jan 26, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
16

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
22D0946656Dialysis Clinic, Inc - Ball Square643 Broadway Street, Somerville, MA 02145Certificate of waiverMay 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dialysis Clinic Inc238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 3

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

Locations

615 Park St
Jacksonville, FL 32204
Phone (904) 354-0409

1011 Surrey St
Lafayette, LA 70501
Phone (337) 289-1952

643 Broadway
Somerville, MA 02145
Phone (617) 616-3600

605 W Due West Ave
Madison, TN 37115
Phone (615) 259-0852

1600 Hayes St
Nashville, TN 37203
Phone (615) 327-3302

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 12

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787616000000",
    "number": "1972536357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 BROADWAY",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452528",
            "telephone_number": "617-616-3600",
            "fax_number": "617-616-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 BROADWAY",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452528",
            "telephone_number": "617-956-6389",
            "fax_number": "617-616-3699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "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."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MA",
            "license": "E90R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1312286",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

Verify at the official NPI Registry.