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

Active since July 16, 2018CLIA 39D2156471 · Waiver
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: April 26, 2024. Verified against the NPPES registry weekly; last sync: September 06, 2026.

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

About Roosevelt Avenue Dialysis NPPES

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

ROOSEVELT AVENUE DIALYSIS (NPI 1881170504) 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 holds a CLIA Waiver certificate valid through October 17, 2026 and 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 · (615) 341-6410 · Fax (888) 662-8259
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 UpdateApril 26, 20243 updates tracked since enumeration
NPPES CertifiedApril 26, 2024
✔ 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
Open in Google Maps ↗

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, 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 39D2156471

Roosevelt Avenue Dialysis · York, PA
Active · expires Oct 17, 2026
CLIA Number39D2156471
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateOctober 18, 2024
Certificate Expiration DateOctober 17, 2026
Laboratory DirectorDr. Sayed A. Kazi
Laboratory Phone(717) 767-0189
Laboratory LocationRoosevelt Avenue Dialysis1695 Roosevelt Ave, Suite A, York, PA 17408
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 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.

Does Cannon Dialysis LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D2156471) is associated with this NPI, valid through October 17, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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 Health of Delaware, Ambetter from Buckeye Health Plan, 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 April 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.