Farragut Dialysis, LLC

Primary specialty

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

License

S5112 Issued in AL

Legal business name

FARRAGUT DIALYSIS, LLC

Practice address

2958 Dorchester Dr
Montgomery, AL 36116-3193

Phone

(334) 280-4980

Fax

(334) 280-1809

NPI assigned

Mar 22, 2013

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

• Monarch Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Listed as

DaVita Monarch DialysisCCN 012669

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Aug 22, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

22

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.

• Bainbridge Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Worth, TX
  • NPI 1699041152

  Member Of

  NPD member
• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Donna, TX
  • NPI 1902353543

  Member Of

  NPD member

Affiliated clinicians 2

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

• Apoorv Deotare, MD

  • Nephrology Physician
  • Montgomery, AL
  • NPI 1487149134

  Dialysis facility

  Care Compare affiliation Name & address match
• Sumeet Munjal, MD

  • Nephrology Physician
  • Montgomery, AL
  • NPI 1578819546

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1992047450",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2958 DORCHESTER DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361163193",
            "telephone_number": "334-280-4980",
            "fax_number": "334-280-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARRAGUT DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "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": "AL",
            "license": "S5112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154843",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monarch Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber Ehsan Faquih, MD
• Kenneth Farris Farha, DDS
• April Farmer, CRNP
• Rodney Leon Farmer, DO
• Ahsan Farooq, MD
• Jennifer Farrior, CRNP
• Father Walter Memorial Child Care Center
• Elizabeth Faulk, CRNP
• Vicki Dorman Faulk, R.PH.
• Faulkner University

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Montgomery, AL
• Providers in Montgomery, AL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.