JACKSON SOUTH DIALYSIS
NPI 1710932090
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Jackson, MS

Q: What is Isd Renal Inc's NPI number?

The NPI number for Isd Renal Inc is 1710932090. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Jackson South Dialysis.

Q: What is Isd Renal 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 Isd Renal Inc have?

CMS rates DaVita Jackson South Dialysis 2 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

Q: When was this NPI record last updated?

The NPPES record for Isd Renal Inc was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.

Active since May 24, 2006CLIA 25D0866749 · Waiver

2/5

Overall Rating

1015 I 20 FRONTAGE RD, JACKSON, MS 39204(601) 373-9154(601) 960-0749 Get Directions Write a Review

NPPES record last updated: November 19, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Nov 19, 2024, Feb 2, 2022, May 5, 2021 and 3 more (6 updates tracked since 2016).

On this page

About Jackson South Dialysis NPPES

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

JACKSON SOUTH DIALYSIS (NPI 1710932090) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Jackson, Mississippi and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Samuel T Wey, Vp, Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1710932090

Entity TypeOrganization

Primary Taxonomy261QE0700X

Legal Business NameISD RENAL INC

Location Address1015 I 20 FRONTAGE RDJackson, MS 39204-5807

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

Phone(601) 373-9154

Fax(601) 960-0749

Organization SubpartNo

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

Enumeration DateMay 24, 2006

Last NPPES UpdateNovember 19, 20246 updates tracked since enumeration

NPPES CertifiedNovember 19, 2024

✔ NPI 1710932090 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

1015 I 20 FRONTAGE RD, Jackson, MS 39204

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Other Names 1

Doing Business AsJackson South Dialysis

Other Identifiers 1

Medicaid00220355MS

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 25D0866749

Jackson South Dialysis · Jackson, MS

Active · expires Aug 31, 2026

CLIA Number25D0866749

Laboratory TypeEnd Stage Renal Disease Dialysis Facility

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorGary Davis

Laboratory Phone(601) 373-9154

Laboratory LocationJackson South Dialysis1015 I-20 Frontage Rd, Jackson, MS 39204

CLIA data matches this NPI record on: Address Name Phone

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

Certificate of Waiver 25D1003048

Jackson Southwest Dialysis · Jackson, MS

Expired · Aug 20, 2026

CLIA Number25D1003048

Laboratory TypeEnd Stage Renal Disease Dialysis Facility

Certificate Effective DateAugust 21, 2024

Certificate Expiration DateAugust 20, 2026

Laboratory DirectorBabatunde Olutade

Laboratory Phone(601) 373-9154

Laboratory LocationJackson Southwest Dialysis1828 Raymond Road, Jackson, MS 39204

CLIA data matches this NPI record on: 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 Jackson South Dialysis (CMS certification number 252535), from CMS Care Compare.

DaVita Jackson South Dialysis

Dialysis facility · Jackson, MS

2/5 CMS RatingRating period January 2020 to December 2023

OwnershipProfit

ChainDaVita

CMS Certification Number252535

ESRD NetworkNetwork 8

Hemodialysis Stations35

Medicare-Certified SinceAugust 31, 1992

Location1015 I-20 FRONTAGE RDJackson, MS 39204 · Hinds County

Phone(601) 373-9154

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 Isd Renal Inc's NPI number?

The NPI number for Isd Renal Inc is 1710932090. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Jackson South Dialysis.

Where is Isd Renal Inc located?

Isd Renal Inc is located at 1015 I 20 Frontage Rd, Jackson, MS 39204. The listed phone number is (601) 373-9154.

What is Isd Renal 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 Isd Renal Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0866749) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Isd Renal Inc a Medicare-certified dialysis facility?

Yes. DaVita Jackson South Dialysis is a Medicare-certified dialysis facility, certified since August 31, 1992.

What quality rating does Isd Renal Inc have?

CMS rates DaVita Jackson South Dialysis 2 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

What insurance does Isd Renal Inc accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Isd Renal 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 Isd Renal Inc was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.