SOUTH BROAD STREET DIALYSIS
NPI 1104095041
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Philadelphia, PA
Overall Rating: 1 out of 5 stars
NPI Status: Active since February 25, 2008
Contact Information
1172 S BROAD ST
PHILADELPHIA, PA
ZIP 19146
Phone: (215) 875-6720
Fax: (215) 875-6721
- Organization
- Clinic/Center
- End-Stage Renal Disease (ESRD) Treatment
- Accepts Insurance
- CLIA Number: 39D1090639
- CLIA Cert. Type: End Stage Renal Disease Dialysis Facility
- CLIA Exp. Date: 10-15-2026
About SOUTH BROAD STREET DIALYSIS
This page provides the complete NPI Profile along with additional information for South Broad Street Dialysis, a provider established in Philadelphia, Pennsylvania operating as a Clinic/center, focusing in end-stage renal disease (esrd) treatment . The healthcare provider is registered in the NPI registry with number 1104095041 assigned on February 2008. The practitioner's primary taxonomy code is 261QE0700X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as South Broad Street Dialysis. The authorized official of this NPI record is Samuel Wey (Vp, Licensure & Certification)
- NPI
- 1104095041
- Provider Legal Name
- RENAL TREATMENT CENTERS NORTHEAST INC
- Other Organization Name
- SOUTH BROAD STREET DIALYSIS
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1172 S BROAD ST PHILADELPHIA, PA 19146
- Location Phone
- (215) 875-6720
- Location Fax
- (215) 875-6721
- Mailing Address
- 5200 VIRGINIA WAY L&C DEPT BRENTWOOD, TN 37027
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-25-2008
- Last Update Date
- 01-06-2025
- Code Navigator
According to the Dialysis Facility Compare program data, South Broad Street Dialysis has a much below average overall quality rating based on the patient's quality of care based on data that dialysis centers report to Medicare. The Quality of Patient Star Rating for this facility is 1 out of 5 stars.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center End-Stage Renal Disease (ESRD) Treatment
- Taxonomy Code
- 261QE0700X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Clear Gold - HMO
- Clear Gold + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Focused Silver - HMO
- Focused Silver + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Principal Bronze HSA - EPO
- Principal Bronze HSA + Vision + Adult Dental - EPO
- Standard Expanded Bronze - EPO
- Standard Expanded Bronze + Vision + Adult Dental - EPO
- Standard Gold - EPO
- Standard Gold + Vision + Adult Dental - EPO
- Standard Silver - EPO
- Bronze Classic 4700 - HMO
- Bronze Classic Standard - HMO
- Bronze Elite + PCP Saver Plus - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Bronze Simple Chronic Care CKM - HMO
- Bronze Simple Diabetes - HMO
- Gold Classic - HMO
- Gold Classic Standard - HMO
- Gold Elite Saver Plus - HMO
- Silver Classic Standard - HMO
- Silver Elite Saver Plus - HMO
- Silver Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Silver Simple Chronic Care CKM - HMO
- Silver Simple Diabetes - HMO
- Silver Simple PCP Saver - HMO
- Silver Simple Women's Health with Menopause Benefits - HMO
- Bronze Classic 4700 - HMO
- Bronze Classic 4700 | with AdventHealth - HMO
- Bronze Classic Standard - HMO
- Bronze Classic Standard | with AdventHealth - HMO
- Bronze Elite + PCP Saver Plus - HMO
- Bronze Elite + PCP Saver Plus | with AdventHealth - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Bronze Simple Chronic Care CKM - HMO
- Bronze Simple Diabetes - HMO
- Gold Classic Standard - HMO
- Gold Classic Standard | with AdventHealth - HMO
- Gold Elite Saver Plus | with AdventHealth - HMO
- Gold Simple - HMO
- Gold Simple | with AdventHealth - HMO
- Silver Classic Standard - HMO
- Silver Classic Standard | with AdventHealth - HMO
- Silver Elite - HMO
- Silver Elite | with AdventHealth - HMO
- Silver Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Silver Simple Chronic Care CKM - HMO
- Bronze Classic 4700 - HMO
- Bronze Classic 4700 | with Atrium Health - HMO
- Bronze Classic Standard - HMO
- Bronze Classic Standard | with Atrium Health - HMO
- Bronze Elite + PCP Saver Plus - HMO
- Bronze Elite + PCP Saver Plus | with Atrium Health - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health - HMO
- Bronze Simple Chronic Care CKM | with Atrium Health - HMO
- Bronze Simple Diabetes | with Atrium Health - HMO
- Gold Classic Standard - HMO
- Gold Classic Standard | with Atrium Health - HMO
- Silver Classic - HMO
- Silver Classic | with Atrium Health - HMO
- Silver Classic Standard - HMO
- Silver Classic Standard | with Atrium Health - HMO
- Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health - HMO
- Silver Simple Chronic Care CKM | with Atrium Health - HMO
- Silver Simple Diabetes - HMO
- Silver Simple Diabetes | with Atrium Health - HMO
- Silver Simple PCP Saver - HMO
- Bronze Classic Standard - HMO
- Bronze Elite + PCP Saver Plus - HMO
- Bronze Simple - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Bronze Simple Chronic Care CKM - HMO
- Buena Salud Bronce Simple Para Diabetes - HMO
- Gold Classic - HMO
- Gold Classic Standard - HMO
- Gold Simple - HMO
- Gold Simple Diabetes - HMO
- Silver Classic Standard - HMO
- Silver Elite Saver Plus - HMO
- Silver Simple Chronic Care CKM - HMO
- Silver Simple Diabetes - HMO
- Silver Simple PCP Saver - HMO
- Silver Simple Specialist Saver with COPD - HMO
- Silver Simple Women's Health with Menopause Benefits - HMO
- Bronze Classic - EPO
- Bronze Classic | with Bryan Health - EPO
- Bronze Classic 4700 - EPO
- Bronze Classic 4700 | MercyOne - EPO
- Bronze Classic Standard - EPO
- Bronze Classic Standard - PPO
- Bronze Classic Standard | MercyOne - EPO
- Bronze Classic Standard | with Bryan Health - EPO
- Bronze Elite + PCP Saver - EPO
- Bronze Elite + PCP Saver Plus - EPO
- Bronze Elite + PCP Saver Plus - PPO
- Bronze Elite + PCP Saver Plus | MercyOne - EPO
- Bronze Elite + PCP Saver Plus | with Bryan Health - EPO
- Bronze Simple - EPO
- Bronze Simple - PPO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - EPO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - PPO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits | MercyOne - EPO
- Bronze Simple Chronic Care CKM - EPO
- Bronze Simple Chronic Care CKM - PPO
- Bronze Classic PCP Saver | Cleveland Clinic - HMO
- Bronze Classic Standard | Cleveland Clinic - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits | Cleveland Clinic - HMO
- Bronze Simple Chronic Care CKM | Cleveland Clinic - HMO
- Bronze Simple Diabetes | Cleveland Clinic - HMO
- Bronze Simple HSA | Cleveland Clinic - HMO
- Gold Classic Standard | Cleveland Clinic - HMO
- Gold Elite | Cleveland Clinic - HMO
- Gold Elite Saver Plus | Cleveland Clinic - HMO
- Silver Classic Standard | Cleveland Clinic - HMO
- Silver Elite Saver Plus | Cleveland Clinic - HMO
- Silver Simple Breathe Easy with Enhanced COPD Benefits | Cleveland Clinic - HMO
- Silver Simple Chronic Care CKM | Cleveland Clinic - HMO
- Silver Simple Diabetes | Cleveland Clinic - HMO
- Silver Simple PCP Saver | Cleveland Clinic - HMO
- Silver Simple Women's Health with Menopause Benefits | Cleveland Clinic - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Copay Focus (No Referrals) - HMO
- UHC Bronze Copay Focus (Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Copay Focus + (Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded (Dental + Vision) - HMO
- UHC Bronze Essential - HMO
- UHC Bronze Essential- - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential- ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Essential (No Referrals) - EPO
- UHC Bronze Essential (No Referrals) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100729430 0033 | MEDICAID (05) | PA |
Dialysis Facility Compare Information
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 39D1090639
- Facility Type
- End Stage Renal Disease Dialysis Facility
- Certificate Effective Date
- October 16, 2024
- Certificate Expiration Date
- October 15, 2026
- Laboratory Director
- EDWARD J. FILIPPONE MD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to South Broad Street Dialysis to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104095041, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 49. The final step is to find the difference between that total and the next multiple of ten (50 - 49 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 49 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104095041, enumerated as an "organization" on February 25, 2008.
The provider is located at 1172 S BROAD ST PHILADELPHIA, PA 19146 and the phone number is (215) 875-6720.
Clinic/Center with taxonomy code 261QE0700X and a focus in End-Stage Renal Disease (ESRD) Treatment.
The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter. Please consult your insurance carrier or call the provider to verify.
