SOUTH BROAD STREET DIALYSIS
NPI 1104095041
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Philadelphia, PA

Q: What is Renal Treatment Centers Northeast Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Q: What quality rating does Renal Treatment Centers Northeast Inc have?

CMS rates DaVita South Broad Street Dialysis 1 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

Active since February 25, 2008CLIA 39D1090639 · Waiver

1/5

Overall Rating

1172 S BROAD ST, PHILADELPHIA, PA 19146(215) 875-6720(215) 875-6721 Get Directions Write a Review

NPPES record last updated: January 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 6, 2025, Jun 17, 2020, Aug 23, 2019 and 1 more (4 updates tracked since 2019).

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About South Broad Street Dialysis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH BROAD STREET DIALYSIS (NPI 1104095041) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Philadelphia, Pennsylvania and active in the NPI registry since February 2008. The organization holds a CLIA Waiver certificate valid through October 15, 2026 and lists Samuel Wey, Vp, Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1104095041

Entity TypeOrganization

Primary Taxonomy261QE0700X

Legal Business NameRENAL TREATMENT CENTERS NORTHEAST INC

Location Address1172 S BROAD STPhiladelphia, PA 19146-3142

Mailing Address5200 Virginia Way, L&c DeptBrentwood, TN 37027-7569

Phone(215) 875-6720

Fax(215) 875-6721

Organization SubpartNo

Authorized OfficialSamuel WeyVp, Licensure & Certification · (615) 341-6641

Enumeration DateFebruary 25, 2008

Last NPPES UpdateJanuary 6, 20254 updates tracked since enumeration

NPPES CertifiedJanuary 6, 2025

✔ NPI 1104095041 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities

Taxonomy Code261QE0700X

1172 S BROAD ST, Philadelphia, PA 19146

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Other Names 1

Doing Business AsSouth Broad Street Dialysis

Other Identifiers 1

Medicaid100729430 0033PA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D1090639

South Broad Street Dialysis · Philadelphia, PA

Active · expires Oct 15, 2026

CLIA Number39D1090639

Laboratory TypeEnd Stage Renal Disease Dialysis Facility

Certificate Effective DateOctober 16, 2024

Certificate Expiration DateOctober 15, 2026

Laboratory DirectorEdward J. Filippone MD

Laboratory Phone(215) 875-6720

Laboratory LocationSouth Broad Street Dialysis1172 South Broad Street, Philadelphia, PA 19146

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for DaVita South Broad Street Dialysis (CMS certification number 392753), from CMS Care Compare.

DaVita South Broad Street Dialysis

Dialysis facility · Philadelphia, PA

1/5 CMS RatingRating period January 2020 to December 2023

OwnershipProfit

ChainDaVita

CMS Certification Number392753

ESRD NetworkNetwork 4

Hemodialysis Stations24

Medicare-Certified SinceFebruary 11, 2009

Location1172 S Broad StreetPhiladelphia, PA 19146 · Philadelphia County

Phone(215) 875-6720

Services Offered

In-center hemodialysis

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Renal Treatment Centers Northeast Inc's NPI number?

The NPI number for Renal Treatment Centers Northeast Inc is 1104095041. It was assigned to this organization in the NPPES registry on February 25, 2008. The provider is doing business as South Broad Street Dialysis.

Where is Renal Treatment Centers Northeast Inc located?

Renal Treatment Centers Northeast Inc is located at 1172 S Broad St, Philadelphia, PA 19146. The listed phone number is (215) 875-6720.

What is Renal Treatment Centers Northeast Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Renal Treatment Centers Northeast Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D1090639) is associated with this NPI, valid through October 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Renal Treatment Centers Northeast Inc a Medicare-certified dialysis facility?

Yes. DaVita South Broad Street Dialysis is a Medicare-certified dialysis facility, certified since February 11, 2009.

What quality rating does Renal Treatment Centers Northeast Inc have?

CMS rates DaVita South Broad Street Dialysis 1 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

What insurance does Renal Treatment Centers Northeast Inc accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Buckeye Health Plan, Oscar Health Insurance and Oscar Health Maintenance Organization of Florida and 5 other insurers list Renal Treatment Centers Northeast Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Renal Treatment Centers Northeast Inc was last updated on January 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.