US outpatient dialysis universe, mapped
The top 2 chains run 75% of US dialysis. The other 7,856 records are the only ones you can sell into.
For nephrology EHR, dialyzer, water-treatment, vascular-access, transport, and RCM teams selling into outpatient kidney care. DaVita and Fresenius are two phone calls. The market that takes meetings is everything else.
The market, in three numbers
A duopoly with a long tail behind it.
share held by the top 2 chains
DaVita and Fresenius together operate around two thirds of US dialysis clinics by count, and roughly 75 percent of patients by treatment volume because their facilities are larger than the independent average.
share held by the top 10 providers
Add the next eight operators and you are at 84 percent of clinic count. The remaining 16 percent is hospital-affiliated programs, regional non-profits, and a few hundred genuinely independent facilities.
US patients on maintenance dialysis
Roughly 554,000 Americans are on maintenance dialysis, with around 130,000 newly starting therapy each year. Patient volume per clinic is one of the tightest in outpatient healthcare.
Source: Orbital classifier, market Speciality and Surgical Care, June 2026 snapshot.
Methodology
Why our clinic count moves and the published files do not.
The 7,856 number is built from the Medicare-certified dialysis facility universe, then resolved clinic by clinic to the operating entity and refreshed against closures and corporate moves. The Orbital classifier market this universe sits under is Speciality and Surgical Care, which is how we trace dialysis alongside ambulatory surgery centers, ophthalmology platforms, and other multi-site outpatient specialty care.
How the 7,856 figure is built
- Start from the Medicare-certified dialysis facility universe. Every certified facility is mapped with a certification number, address, modality codes, and parent organisation. That is the universe of US outpatient dialysis. Almost every facility is Medicare-certified because Medicare is the primary payer for end-stage renal disease.
- 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 owned by an FMC NA subsidiary. An "independent" clinic is often a joint venture between a hospital, a local nephrology group, and a national platform. We map the legal owner, not just the brand on the door.
- Find the medical director and the administrator. Every certified dialysis facility has a named medical director and a facility administrator. We verify both, plus the nephrology group on the back end where one exists.
- Drop the closed and the merged. Public files leave closed clinics in for a quarter or two. Acquisitions are not reflected until the new owner re-files. We collapse merged sites and remove closures on a rolling cadence.
- Attach a treatment-volume estimate. We use patient-level renal data to sanity-check clinic counts at the state level and to attach a treatment-volume estimate to each facility.
If you want the source breakdown for a specific state or parent chain, ask. We do not hide the working.
By state
Where US dialysis clinics actually are.
Dialysis clinic counts follow population, age, and diabetes prevalence. The Sun Belt and the industrial Midwest are over-indexed. Per capita, the South dominates because end-stage renal disease prevalence is highest there.
| # | 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 |
Source: Orbital classifier, market Speciality and Surgical Care, June 2026 snapshot.
The top ten providers
The largest US dialysis operators by clinic count.
The Orbital count ranks providers by clinic footprint, which matches how vendors size accounts. Ranking the same operators by treatment volume is also a defensible cut. Both rank the same two companies first. The cliff after the top 2 is severe.
| # | Provider | US clinics | Parent / note |
|---|---|---|---|
| 1 | DaVita Kidney Care | ~2,675 | NYSE:DVA. Public. The largest US dialysis operator by clinic count and patient volume. |
| 2 | Fresenius Medical Care North America | ~2,600 | NYSE:FMS. Public. Subsidiary of Fresenius Medical Care AG, headquartered in Germany. |
| 3 | US Renal Care | ~400 | Privately held. Backed by Bain Capital and other investors. Concentrated in the South and Mid-Atlantic. The largest non-public US dialysis platform. |
| 4 | Satellite Healthcare | ~120 | Non-profit. Founded 1974, headquartered in San Jose. Heavy footprint in California and Texas. Strong home-dialysis program. |
| 5 | Innovative Renal Care | ~250 | Formerly American Renal Associates. Privately held after a 2021 take-private. Operates joint-venture clinics with local nephrologists across 27 states. |
| 6 | Dialyze Direct | ~150 | Privately held. Specialises in dialysis delivered inside skilled nursing facilities, a distinct site-of-care model. Backed by The Vistria Group. |
| 7 | Atlantic Dialysis Management Services | ~25 | Privately held. Concentrated in the New York metro. Independent operator with a long-running clinic JV model. |
| 8 | Northwest Kidney Centers | ~20 | Non-profit. The original outpatient dialysis provider, founded in Seattle in 1962 as the first community dialysis centre in the world. |
| 9 | Centers for Dialysis Care | ~25 | Non-profit. Cleveland-based. Concentrated in northeast Ohio. Operates in partnership with the Case Western Reserve University nephrology program. |
| 10 | Dialysis Clinic, Inc. | ~260 | Non-profit. Headquartered in Nashville. Operates across 29 states. The largest non-profit dialysis provider in the US by clinic count. |
Source: Orbital classifier, market Speciality and Surgical Care, June 2026 snapshot.
Our take
Dialysis is not a fragmented market with two big players. It is a duopoly with a rounding error.
We believe
If you sell into outpatient dialysis and you only target the long tail, you are working a 16 percent market and calling it the floor.
The standard vendor playbook in healthcare is to chase the independents because the chains are too hard to crack. In most specialties that math works. In dialysis it does not, because the long tail is small. The top 10 providers run 84 percent of US clinics. The remaining 2,500 sites are split between hospital-affiliated programs, university-tethered non-profits, and a few hundred genuinely independent facilities. There is no comfortable middle to land in.
One of those genuinely independent operators called us last quarter. Two clinics in greater Birmingham, joint-ventured with a local nephrology group, no national affiliation. He had been pitched by three nephrology EHR vendors in the last six months. All three sent the same deck and the same case study from a DaVita corporate pilot. None of them had any idea his contract cycle was tied to the JV nephrology group's payer-mix renewal, not to a corporate procurement calendar. The data tool they were running told them his clinic was independent. It did not tell them why that mattered.
The vendors who win this market sell to the medical director and the facility administrator, not the parent chain. The dataset has to know which of those two is actually authorised to sign. Public records list the names. They do not publish which one returns calls.
Who buys this data
B2B vendors selling into 7,856 clinics.
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 of these. 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, the Orbital data insights hub, and the US gas station universe for vendors selling into the opposite shape of market (extreme fragmentation rather than extreme concentration).
Plain-spoken
When the dialysis dataset is the wrong fit.
Do not buy this if any of the following are true.
You only sell into DaVita and Fresenius. If your motion is one national contract with each, you do not need 7,856 records. You need two procurement contacts and a long lunch. Save your budget.
You are targeting transplant centers or inpatient renal units. Those live inside hospital systems, with completely different procurement, completely different vendors, and a different regulatory file. Different dataset, different shape.
You sell to nephrology private practice that does not own clinics. The dataset is clinic-anchored. If your buyer is a referring nephrologist with no facility ownership, the nephrology group list is the right cut, not the clinic list.
You need patient-level data. Patient-identifiable data is regulated and we do not stand it up here. Aggregate facility quality measures are available from public sources.
The honest version
Why most dialysis providers vendor data is wrong.
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 an aggregator summary citing both. Each is correct in isolation. None of them is what a vendor actually needs. The public facility files are structured for federal quality reporting, not for outbound sales. They list every Medicare-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 around 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, and 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 can 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, quality star rating, and the medical-director-versus-administrator split that determines who actually answers.
One more piece of context worth pricing in. Public facility files refresh on a quarterly cadence. The 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. That is the gap a clinic-by-clinic, person-by-person map closes.
Questions
Before you ask sales about dialysis provider data.
How many dialysis providers are there in the US?
There are 7,856 active outpatient dialysis facilities in the United States, based on Orbital's June 2026 clinic-by-clinic map. Around 554,000 Americans were on maintenance dialysis at last report, almost all of them treated in these outpatient clinics rather than hospitals.
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. No other operator runs more than 400 sites.
What share of the US dialysis market do DaVita and Fresenius hold?
DaVita and Fresenius together operate roughly 67 percent of US dialysis clinics and treat closer to 75 percent of US dialysis patients, because their clinics tend to be larger than the independent average. This is one of the most concentrated B2B verticals in healthcare. The top 10 providers combined hold about 84 percent of clinic count.
Who buys dialysis provider data?
Vendors selling into outpatient nephrology. Nephrology EHR vendors. Dialysis consumables and dialyzer suppliers. Water-treatment system installers 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 targeting independent and mid-market clinics. The common thread is they need the medical director or facility administrator, not the corporate brand.
Can I filter dialysis clinics by state, chain, or modality?
Yes. The dataset is structured so you can filter by state, by parent chain, by CMS facility type, by in-center vs 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 contract, 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 that does not own clinics, this dataset is the wrong shape. It also is not the right tool if you only sell into DaVita and Fresenius corporate procurement, because that is two phone calls, not 7,856 records. And it does not include patient-level data, only the facility and the people who run it.
How accurate is the US dialysis clinic count?
Orbital starts from the Medicare-certified dialysis facility universe and resolves each clinic to its operating entity, refreshes contacts on a rolling schedule, and removes closures that public files leave on for a quarter or two. The count is updated monthly.
Does the dataset include home dialysis providers?
Yes. Home hemodialysis and peritoneal dialysis programs are captured as a modality flag on the underlying clinic record, because almost all home programs are still administered by a parent outpatient facility. Dialyze Direct, which runs in-skilled-nursing-facility hemodialysis as a distinct delivery model, is captured separately by clinic site. Pure direct-to-patient home services without a 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 administrators, no commitment, no email-list back-and-forth.
Get the sample