US outpatient dialysis universe, mapped
US outpatient dialysis packs 84% of its clinics into ten chains. The medical director at each one is where the vendor conversation actually happens.
Updated June 8, 2026
For nephrology EHR, dialyzer and consumables, water-treatment, vascular-access, transport, and RCM vendors selling into outpatient kidney care. DaVita and Fresenius are two corporate conversations. The other 16 percent is where individual clinics and medical directors decide.
Active US outpatient dialysis clinics
iAmericans on maintenance dialysis, treated at these facilities
Share of US dialysis clinics held by DaVita and Fresenius alone
The top ten providers
The ten largest US dialysis operators, by clinic count.
Ranked by US clinic count, not patient volume. Patient-volume rank gives the same top two in the same order, but the cliff after them looks even steeper by volume. The detailed chain notes, ownership structures, and parent-company breakdown sit in Chain-by-chain below.
Who buys this data
Nephrology tech, consumables, and RCM vendors selling into the US outpatient kidney care market.
This page is for the teams selling into dialysis providers, not the providers themselves. The buyer for this dataset usually falls into one of these categories.
EHR
Nephrology EHR vendors
Acumen, CrownWeb-adjacent platforms, and the next wave of cloud nephrology EHR vendors selling the upgrade off a legacy on-prem system. The buyer is the medical director or the IT lead at the parent group, not the corporate procurement office.
Get the sampleConsumables
Dialysis supply
Dialyzer, bloodline, and concentrate suppliers selling into the 16 percent of clinics not on a DaVita or Fresenius corporate contract. The independent and non-profit chains buy through facility administrators on a clinic-by-clinic basis.
Get the samplePlant
Water-treatment systems
Reverse-osmosis water-treatment manufacturers and service techs. Every dialysis clinic in the country runs one. They fail. The replacement cycle is the calling list. The buyer is the biomedical engineer or facility administrator.
Get the sampleAccess
Vascular-access products
Catheter, graft, and arteriovenous fistula tool manufacturers. The buying decision sits with the medical director and the interventional nephrologist on staff, often via the affiliated nephrology group rather than the clinic chain.
Get the sampleTransport
Patient transportation
Non-emergency medical transport companies. Dialysis is the largest single use case for scheduled NEMT in the country, three times a week per patient. The booking decision sits with the clinic social worker or scheduler.
Get the sampleBilling
RCM for dialysis
Revenue-cycle and billing-software vendors that understand the ESRD bundled payment, the AKI carve-outs, and the Medicare Advantage carve-in that took effect in 2021. Independent and non-profit clinics buy this; the public chains build it in-house.
Get the sampleAdjacent universes built the same way: the broader by-industry email lists, and the rest of the Orbital data hub.
The long version
Detail, on demand.
The active US outpatient clinic base is built facility by facility, resolved to the operating entity and refreshed against closures and corporate moves. The Orbital data team tracks dialysis alongside ambulatory surgery centers, ophthalmology platforms, and other multi-site outpatient specialty care.
How the clinic count is built
- Start from the active US dialysis facility universe. Every clinic is mapped with a certification number, address, modality codes, and parent organisation. Medicare is the primary payer for end-stage renal disease, so almost every outpatient clinic is federally certified. That certification file is the floor, not the ceiling.
- Resolve each clinic to a real operating entity. A DaVita-branded clinic in Houston is owned by a DaVita Inc. subsidiary. A Fresenius clinic in the same metro is a different legal entity under a different German parent. An “independent” clinic is often a joint venture between a hospital system, a local nephrology group, and a national platform. We map the legal owner, not just the name on the door.
- Find the medical director and the facility administrator. Every certified dialysis facility has a named medical director and a facility administrator. We verify both contacts, plus the nephrology group on the back end where one is formally affiliated.
- Drop the closed and the merged. Public facility files leave closed clinics on the record for a quarter or two. Acquisitions do not appear until the new owner re-files. We collapse merged sites and remove closures on a rolling cadence, not an annual one.
- Attach a treatment-volume estimate. We use renal data to sanity-check clinic counts at the state level and to attach a treatment-volume estimate to each facility, so vendors know whether a clinic runs 40 patient sessions per week or 200.
If you want the source breakdown for a specific state or parent chain, ask. We do not hide the working.
Ranked by US clinic count, not global revenue. The interesting column is ownership structure: public, private-equity-backed, non-profit JV, and independent each carry a different buying process and a different decision timeline.
| # | Provider | Parent / structure | US clinics | Notes |
|---|---|---|---|---|
| 1 | DaVita Kidney Care | DaVita Inc. NYSE: DVA. Publicly traded. | ~2,675 | Largest US dialysis operator by clinic count and patient volume. Publicly traded on the NYSE under DVA. National corporate procurement team handles most vendor contracts at the chain level. |
| 2 | Fresenius Medical Care North America | Fresenius Medical Care AG. NYSE: FMS. German parent; publicly traded. | ~2,600 | Subsidiary of the German-headquartered Fresenius Medical Care AG, the largest dialysis company globally. Second-largest US footprint by clinic count; first by global reach and equipment manufacturing. |
| 3 | US Renal Care | Privately held. Backed by Bain Capital. | ~400 | Largest non-public US dialysis platform. Concentrated in the South and Mid-Atlantic. The only independent operator at meaningful scale between the two public giants and the non-profit tier. |
| 4 | Satellite Healthcare | Non-profit. Founded 1974, headquartered in San Jose, CA. | ~120 | California-concentrated non-profit with a strong home-dialysis program. One of the largest non-profit dialysis networks west of the Mississippi. |
| 5 | Innovative Renal Care | Privately held. Formerly American Renal Associates; taken private 2021. | ~250 | Rebranded after a 2021 take-private transaction. Operates joint-venture clinics with local nephrologists across 27 states, making the nephrology group a parallel buyer alongside the facility administrator. |
| 6 | Dialyze Direct | Privately held. Backed by The Vistria Group. | ~150 | Specialises in delivering dialysis inside skilled nursing facilities rather than freestanding clinics. A distinct site-of-care model with a different buyer profile: the SNF administrator rather than an outpatient medical director. |
| 7 | Atlantic Dialysis Management Services | Privately held. New York metropolitan area. | ~25 | Long-running independent operator concentrated in the New York metro area. Runs a joint-venture clinic model with local nephrology groups. Limited geographic footprint outside the Northeast. |
| 8 | Northwest Kidney Centers | Non-profit. Seattle, WA. Founded 1962. | ~20 | The original community outpatient dialysis provider, founded in Seattle in 1962 as the first community dialysis centre in the world. Small footprint concentrated in the Pacific Northwest. |
| 9 | Centers for Dialysis Care | Non-profit. Cleveland-based. | ~25 | Northeast Ohio non-profit affiliated with the Case Western Reserve University nephrology program. Regional operator with no national expansion footprint. |
| 10 | Dialysis Clinic, Inc. | Non-profit. Headquartered in Nashville. | ~260 | Largest non-profit dialysis provider in the US by clinic count. Operates across 29 states and partners with nephrology programs at academic medical centres. Independent governance from the two public chains. |
Counts marked “~” are approximate, drawn from corporate disclosures and reconciled against the Orbital clinic map. The ordering above follows the published HTML rank. Source: Orbital data team, June 2026 snapshot.
Dialysis clinic counts follow population, age, and diabetes prevalence. Texas leads by raw count; the South dominates per capita because end-stage renal disease prevalence is highest there. Per 100,000 residents, Louisiana and Alabama run at twice the rate of California or New York.
| # | State | Dialysis clinics | Per 100k residents |
|---|---|---|---|
| 1 | Texas | 770 | 2.5 |
| 2 | California | 650 | 1.7 |
| 3 | Florida | 490 | 2.1 |
| 4 | Georgia | 380 | 3.4 |
| 5 | Ohio | 330 | 2.8 |
| 6 | North Carolina | 320 | 3.0 |
| 7 | Illinois | 310 | 2.5 |
| 8 | New York | 300 | 1.5 |
| 9 | Pennsylvania | 290 | 2.3 |
| 10 | Michigan | 270 | 2.7 |
| 11 | Tennessee | 250 | 3.5 |
| 12 | Virginia | 230 | 2.6 |
| 13 | Louisiana | 220 | 4.8 |
| 14 | Alabama | 200 | 3.9 |
| 15 | South Carolina | 190 | 3.6 |
Counts rounded to the nearest ten for display. The dataset itself is exact, down to facility address and modality mix. Source: Orbital data team, June 2026 snapshot.
We believe
Targeting “all dialysis clinics” without knowing which role signs for your category is the single most common waste of outbound budget in nephrology sales.
The standard vendor playbook in healthcare specialties is to target the independents, because the chains negotiate at corporate. In most verticals that math works. In dialysis it mostly does not, because the independent tail is thin. The 16 percent of clinics outside the top 10 providers is where individual conversations happen. The other 84 percent is owned by ten chains with centralised procurement teams and multi-year contract cycles. That math forces vendors to either win the corporate deal or build a clinic-by-clinic motion for a small addressable segment.
One of those independent operators called us last quarter. Two clinics in the Mid-Atlantic, joint-ventured with a local nephrology group, not affiliated with any national chain. He had been pitched by four nephrology EHR vendors in the prior twelve months. Every pitch assumed his buying process was tied to a corporate renewal calendar. It was not. His contract was driven by the payer-mix renewal schedule from the JV nephrology group, which runs on a different timeline from anything a standard CRM date field captures. The vendors who pitched him were running the wrong clock because their data told them he was independent but did not tell them how his decisions actually moved.
The medical director at a corporate DaVita or Fresenius clinic is not the person who buys the RCM software. That is a national procurement team. But the same medical director is often the person who buys vascular-access tools, catheter kits, and staff training. The lines are drawn by product category, not by chain affiliation, and that distinction does not appear in any public facility file.
Do not buy this if any of the following are true.
You only sell into DaVita and Fresenius corporate procurement. If your motion is a single national contract with each chain, you need two phone numbers and a long lunch. You do not need a clinic-by-clinic list. Save your budget.
You are targeting transplant centers or inpatient renal units. Hospital-based renal programs operate inside a completely different procurement structure, with different decision-makers and a different regulatory file. The dataset here covers freestanding and hospital-affiliated outpatient clinics, not inpatient or surgical units.
You sell to nephrology private practice that does not own clinics. A referring nephrologist who sees patients in a DaVita clinic but holds no ownership stake is not in this dataset. The nephrology group list is the right cut, not the outpatient clinic list.
You need patient-level data. Patient-identifiable clinical information is regulated under HIPAA and we do not stand it up here. Aggregate facility quality measures come from public CMS sources and are out of scope for outbound sales use.
If you Google “largest dialysis providers in the US,” the top results are usually an investor-relations page at DaVita, a Fresenius press release, and a trade-press aggregator citing both. Each is correct in isolation. None is what a vendor actually needs. The public facility files are structured for federal quality reporting, not for outbound sales. They list every certified facility, every medical director by name, every modality flag, and almost no current contact information you can actually dial. That gap is the entire problem.
The next problem is the chain framing. Enterprise data tools index by company, so “DaVita” looks like one customer with roughly 2,675 locations and a single phone number. For some vendors that is correct. For most it is not. DaVita corporate signs one set of contracts. The local medical director at a DaVita clinic signs a different set. The affiliated nephrology group that staffs the clinic signs a third. The buyer for a vascular-access tool is rarely the same person who buys the bundled-payment RCM software. The big database returns one row per chain. The reality is three roles per clinic and a different decision-maker for each line item.
This is the gap Orbital was built to close. We map the universe of US small and mid-market healthcare facilities, find the operator and the named decision-maker for each one, and validate the contact before it reaches you. Nothing about that is dialysis-specific, which is why we also map ambulatory surgery centers, ophthalmology platforms, urgent care, and other specialty-care shapes the same way. What is specific to dialysis is the layer on top: chain affiliation, modality mix, joint-venture structure, and the medical-director-versus-administrator split that determines who actually answers.
One more thing worth pricing in. Public facility files refresh on a quarterly cadence. Patient-level annual reports refresh once a year. Aggregator summaries lag both. For a vendor doing outbound this quarter, the question is which clinics are open this Monday, which medical director is at the desk, and which administrator returns calls. A clinic-by-clinic, person-by-person map refreshed monthly is not the same tool as an analyst PDF updated in January.
Questions
Before you ask sales about dialysis provider data.
How many dialysis providers are there in the US?
The Orbital clinic map covers just under 8,000 active outpatient dialysis facilities across all 50 states, built from CMS certification records and refreshed monthly against facility-level signals. Almost all are freestanding outpatient clinics rather than hospital inpatient units. Around 554,000 Americans are on maintenance dialysis at last count, with roughly 130,000 new patients starting therapy each year.
Who is the largest dialysis provider in the US?
DaVita Kidney Care, listed on the NYSE under DVA, operates the largest US footprint at roughly 2,675 clinics. Fresenius Medical Care North America follows with around 2,600 clinics. Together those two companies treat about three out of every four US dialysis patients by treatment volume. No other operator runs more than 400 sites.
What share of the US dialysis market do DaVita and Fresenius hold?
By clinic count, DaVita and Fresenius together operate roughly 67 percent of US dialysis facilities. By treatment volume they are closer to 75 percent, because their clinics run more patient sessions per week than the independent average. Both numbers point to the same conclusion: this is one of the most concentrated outpatient B2B verticals in US healthcare. The top 10 providers combined account for about 84 percent of clinic count.
Who buys dialysis provider data?
Vendors selling into outpatient nephrology. Nephrology EHR platforms. Dialysis consumable and dialyzer suppliers. Water-treatment system manufacturers and service techs. Vascular-access product manufacturers selling catheters, grafts, and fistula tools. Non-emergency medical transport companies booked through clinic schedulers. Revenue-cycle and billing software vendors that understand the ESRD bundled payment. The common thread: they need the medical director or facility administrator, not just the corporate brand on the building.
Can I filter dialysis clinics by state, chain, or modality?
Yes. The dataset filters by state, by parent chain, by CMS facility type, by in-center versus home modality mix, and by whether the clinic is hospital-affiliated or freestanding. Most vendors filter on chain affiliation first and state second, because the buyer at a DaVita corporate clinic is a national procurement team, not the local medical director.
When is the dialysis dataset the wrong fit?
If your product targets transplant centers, hospital inpatient renal units, or nephrology private practice without clinic ownership, the dataset shape is wrong. It also is not the right tool if your motion is purely a national corporate contract with the two largest chains, because that is two conversations, not a clinic-level outbound motion. And it does not include patient-identifiable data, only the facility and the named people who run it.
How accurate is the US dialysis clinic count?
Orbital builds from the active CMS-certified facility file, resolves each clinic to its operating entity, and removes closures on a rolling monthly schedule. Public files leave closed clinics on the record for a quarter or more; we do not. Acquisitions and re-brandings land in the dataset weeks after they happen rather than waiting for the next annual report cycle.
Does the dataset include home dialysis providers?
Yes. Home hemodialysis and peritoneal dialysis programs are captured as a modality flag on the parent outpatient clinic record, because almost all home programs are still administered by a freestanding facility. Dialyze Direct, which delivers in-skilled-nursing-facility hemodialysis as a distinct site-of-care model, is mapped by individual site. Pure direct-to-patient home services with no freestanding clinic touchpoint are out of scope.
See the dialysis clinic dataset before you pay for it.
Tell us the states, chain affiliations, or modality mix you want. We send a free sample of around 100 verified clinic records with named medical directors and facility administrators, no commitment, no email-list back-and-forth. For the full universe count and segment breakdown, ask us directly.
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