NPIMap

Organization Active NPI

Total Renal Care, Inc.

Doing business as Fruitland Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fruitland, ID
National Provider Identifier
1083146559
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
TOTAL RENAL CARE, INC.
Doing business as
Fruitland Dialysis
Practice address
815 NW 13TH St
Fruitland, ID 83619-2316
Phone
(208) 764-1487
Fax
(208) 764-1488
NPI assigned
Apr 3, 2017
Last updated
Oct 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

815 NW 13TH St
Fruitland, ID 83619-2316

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1083146559MedicaidID

Other names 1

  • Fruitland Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180419001096 ID Part A Provider - End-Stage Renal Disease Facility (ESRD) 0749473072 Practice locations: Fruitland, ID

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Fruitland DialysisCCN 132533
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Feb 15, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2132636Fruitland Dialysis815 NW 13TH St, Fruitland, ID 83619Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Springdale Dialysis758 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 9

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

815 NW 13th St
Fruitland, ID 83619
Phone (208) 764-1487

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1083146559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 NW 13TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192316",
            "telephone_number": "208-764-1487",
            "fax_number": "208-764-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083146559",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fruitland Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fruitland Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.