Bliss Dialysis LLC

Primary specialty

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

Legal business name

BLISS DIALYSIS LLC

Doing business as

Berkshire Home Training

Practice address

4800 W San Antonio St
Ste 201
Broken Arrow, OK 74012-6156

Phone

(918) 249-9716

Fax

(918) 254-4173

NPI assigned

Oct 26, 2012

Last updated

Nov 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sam Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Berkshire Home Training Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Listed as

DaVita Berkshire Home Training PDCCN 372591

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jun 24, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

11

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 Walker South Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Walker, LA
  • NPI 1841682200

  Member Of

  NPD member

Locations

Affiliated clinicians 2

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

• Sunil Agrawal, MD

  • Nephrology Physician
  • Tulsa, OK
  • NPI 1093953747

  Dialysis facility

  Care Compare affiliation Name & address match
• Janet Elaine Russell, MD

  • Nephrology Physician
  • Tulsa, OK
  • NPI 1780691501

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1982957064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 W SAN ANTONIO ST",
            "address_2": "STE 201",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126156",
            "telephone_number": "918-249-9716",
            "fax_number": "918-254-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLISS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAM",
        "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": "200518030A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkshire Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Berkshire Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryanna Blake, OT
• Chelsey Diana Blakley
• Jamie Blalack
• Abigail Blansett
• Zachary Blanton, DC
• Shanae Block
• Sarah E Blotevogel, DPT
• Blueprint Signature Services LLC
• Board of Regents of the University of Oklahoma Ou Physicians Tulsa (OU Physicians Tulsa CSOS Broken Arrow)
• Sally Margaret Bock X, DDS

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.