Renal Treatment Centers-Illinois Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

RENAL TREATMENT CENTERS-ILLINOIS INC

Practice address

6601 Lyndale Ave S
Suite 150
Richfield, MN 55423-2490

Phone

(612) 869-2118

Fax

(612) 869-2219

NPI assigned

Apr 13, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Richfield Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

DaVita Richfield DialysisCCN 242563

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Dec 16, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Tax ID family

Renal Treatment Centers - Illinois Inc85 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

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

• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eden Prairie, MN
  • NPI 1962466441
  NPD tax ID
• Renal Treatment Centers-Illinois Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • St Louis Park, MN
  • NPI 1447214812
  NPD tax ID

Affiliated clinicians 6

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

• Mirna Georges Boumitri, M.D.

  • Nephrology Physician
  • Minneapolis, MN
  • NPI 1053580092

  Dialysis facility

  Care Compare affiliation Name & address match
• Kirsten Lee Johansen, MD

  • Nephrology Physician
  • Minneapolis, MN
  • NPI 1124193875

  Dialysis facility

  Care Compare affiliation Name & address match
• Andrew Emil Kummer, M.D.

  • Nephrology Physician
  • Saint Paul, MN
  • NPI 1205098464

  Dialysis facility

  Care Compare affiliation Name & address match
• Teija Madhusoodanan

  • Nephrology Physician
  • Edina, MN
  • NPI 1902338791

  Dialysis facility

  Care Compare affiliation Name & address match
• George Thomas O'Bryan, M.D.

  • Nephrology Physician
  • Edina, MN
  • NPI 1417061904

  Dialysis facility

  Care Compare affiliation Name & address match
• Deepti Devi Torri, M.D.

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1861650061

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1083678445",
    "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": "6601 LYNDALE AVE S",
            "address_2": "SUITE 150",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232490",
            "telephone_number": "612-869-2118",
            "fax_number": "612-869-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4315693000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richfield Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wayne John Raiter, MA LICSW
• Megan E Rapisarda
• RBF LLC
• Lindsey Reinsel
• Nancy A. Reischl, R.N.
• Brett Retzlaff, PHARMD
• James Francis Rian, P.T.
• Kathryn Richardson
• Laura Richardson, DPT
• Richfield Chiropractic PA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Richfield, MN
• Providers in Richfield, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.