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PROVIDENT DIALYSIS CENTER
NPI 1578170221
Technician, Other - Renal Dialysis in Chicago, IL

Active since September 28, 2020CLIA 14D2216191 · Waiver
430 EAST 51ST PL, CHICAGO, IL 60615(312) 864-0200 Get Directions Write a Review

NPPES record last updated: March 16, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 29, 2020, Sep 28, 2020 (2 updates tracked since 2020).

About Provident Dialysis Center NPPES

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

PROVIDENT DIALYSIS CENTER (NPI 1578170221) is a healthcare organization registered as a renal dialysis in Chicago, Illinois and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through March 9, 2027 and lists Scott Andrle, Director Of Managed Care, as its authorized official.

NPPES Registry Identity

NPI1578170221
Entity TypeOrganization
Primary Taxonomy2472R0900X
Legal Business NameCOOK COUNTY
Location Address430 EAST 51ST PLChicago, IL 60615
Mailing Address430 East 51st PlChicago, IL 60615 · (312) 864-0200
Phone(312) 864-0200
Organization SubpartYes
Authorized OfficialScott AndrleDirector Of Managed Care · (312) 864-4649
Enumeration DateSeptember 28, 2020
Last NPPES UpdateMarch 16, 20222 updates tracked since enumeration
NPPES CertifiedMarch 16, 2022
✔ NPI 1578170221 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyTechnician, Other · Renal DialysisTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code2472R0900X
430 EAST 51ST PL, Chicago, IL 60615
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Other Names 1

Doing Business AsProvident Dialysis Center

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 14D2216191

Provident Dialysis Center · Chicago, IL
Active · expires Mar 9, 2027
CLIA Number14D2216191
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateMarch 10, 2025
Certificate Expiration DateMarch 9, 2027
Laboratory DirectorKalyani Perumal
Laboratory Phone(708) 645-1000
Laboratory LocationProvident Dialysis Center430 E 50th Place, Chicago, IL 60615
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COOK COUNTY
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
430 EAST 51ST PL
CHICAGO, IL 60615
Cook County (312) 864-0200

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 Cook County's NPI number?

The NPI number for Cook County is 1578170221. It was assigned to this organization in the NPPES registry on September 28, 2020. The provider is doing business as Provident Dialysis Center.

Where is Cook County located?

Cook County is located at 430 East 51st Pl, Chicago, IL 60615. The listed phone number is (312) 864-0200.

What is Cook County's specialty?

The primary specialty registered for this NPI is Technician, Other, specializing in Renal Dialysis, with taxonomy code 2472R0900X.

Does Cook County hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2216191) is associated with this NPI, valid through March 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Cook County was last updated on March 16, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.