NPIMap

Organization Active NPI

Dialysis Clinic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Albany, GA
National Provider Identifier
1992738371
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001039 Issued in GA
Legal business name
DIALYSIS CLINIC, INC.
Practice address
1314 Radium Springs Rd # 20
Albany, GA 31705-3620
Phone
(229) 434-1175
Fax
(229) 434-1459
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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 ESRD001039 GA Primary

Addresses

Primary practice location

1314 Radium Springs Rd # 20
Albany, GA 31705-3620

Mailing address

337 5TH Ave
Albany, GA 31701-2029
Phone (229) 888-3996

Other identifiers 2

IdentifierTypeStateIssuer
000407393CMedicaidGA
00407393BMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100212000327 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4284541129 Practice locations: Albany, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Dci East AlbanyCCN 112587
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Aug 18, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Dialysis Clinic, Inc.
Dialysis stations
20

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
11D0875449East of the Flint Dialysis Clinic Inc1314 Radium Springs Road, Albany, GA 31705Certificate of waiverAug 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Elbert P Tuttle Jr MD238 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

Locations

1314 Radium Springs Rd
#20
Albany, GA 31705
Phone (229) 434-1175

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 3

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": "1696464000000",
    "number": "1992738371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 5TH AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012029",
            "telephone_number": "229-888-3996",
            "fax_number": "229-888-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 RADIUM SPRINGS RD # 20",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317053620",
            "telephone_number": "229-434-1175",
            "fax_number": "229-434-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "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": "GA",
            "license": "ESRD001039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000407393C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00407393B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

Verify at the official NPI Registry.