Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CANNON DIALYSIS LLC
NPI 1881170504
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in York, PA

Q: What is Cannon Dialysis LLC's NPI number?

The NPI number for Cannon Dialysis LLC is 1881170504. It was assigned to this organization in the NPPES registry on July 16, 2018. The provider is doing business as Roosevelt Avenue Dialysis.

Q: What is Cannon Dialysis LLC'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 Cannon Dialysis LLC have?

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

Active since July 16, 2018

2/5

Overall Rating

1695 ROOSEVELT AVE, STE A, YORK, PA 17408(717) 767-0189(717) 767-0194 Get Directions Write a Review

NPPES record last updated: October 23, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Apr 26, 2024, Mar 31, 2021, Jul 16, 2018 (3 updates tracked since 2018).

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About Cannon Dialysis Llc NPPES

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

CANNON DIALYSIS LLC (NPI 1881170504), doing business as Roosevelt Avenue Dialysis, is a healthcare organization registered as an end-stage renal disease (esrd) treatment in York, Pennsylvania and active in the NPI registry since July 2018. The organization lists Samuel T Wey, Vp Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1881170504

Entity TypeOrganization

Primary Taxonomy261QE0700X

Legal Business NameCANNON DIALYSIS LLC

Location Address1695 ROOSEVELT AVE, STE AYork, PA 17408-8521

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

Phone(717) 767-0189

Fax(717) 767-0194

Organization SubpartNo

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

Enumeration DateJuly 16, 2018

Last NPPES UpdateOctober 23, 20263 updates tracked since enumeration

NPPES CertifiedOctober 23, 2026

✔ NPI 1881170504 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

1695 ROOSEVELT AVE, York, PA 17408

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Other Names 1

Doing Business AsRoosevelt Avenue Dialysis

Other Identifiers 1

Medicaid103704953PA

Accepted Insurance

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

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for DaVita Roosevelt Avenue Dialysis (CMS certification number 392883), from CMS Care Compare.

DaVita Roosevelt Avenue Dialysis

Dialysis facility · York, PA

2/5 CMS RatingRating period January 2020 to December 2023

OwnershipProfit

ChainDaVita

CMS Certification Number392883

ESRD NetworkNetwork 4

Hemodialysis Stations12

Medicare-Certified SinceApril 23, 2019

Location1695 Roosevelt Ave., Suite AYork, PA 17408 · York County

Phone(717) 767-0189

Services Offered

In-center hemodialysis Peritoneal dialysis

Other Providers at the Same Location NPPES

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

WELLSPAN MEDICAL GROUP

Orthopaedic Surgery

1695 ROOSEVELT AVE
YORK, PA 17408

York County (717) 812-4090

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 Cannon Dialysis LLC's NPI number?

The NPI number for Cannon Dialysis LLC is 1881170504. It was assigned to this organization in the NPPES registry on July 16, 2018. The provider is doing business as Roosevelt Avenue Dialysis.

Where is Cannon Dialysis LLC located?

Cannon Dialysis LLC is located at 1695 Roosevelt Ave Ste A, York, PA 17408. The listed phone number is (717) 767-0189.

What is Cannon Dialysis LLC's specialty?

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

Is Cannon Dialysis LLC a Medicare-certified dialysis facility?

Yes. DaVita Roosevelt Avenue Dialysis is a Medicare-certified dialysis facility, certified since April 23, 2019.

What quality rating does Cannon Dialysis LLC have?

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

What insurance does Cannon Dialysis LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Oscar Health, Oscar Health Insurance and Oscar Health Maintenance Organization of Florida and 5 other insurers list Cannon Dialysis LLC 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 Cannon Dialysis LLC was last updated on October 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 days 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.