Renal Care Group Arizona, LLC

Primary specialty

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

Legal business name

RENAL CARE GROUP ARIZONA, LLC

Doing business as

Renal Care Group - Mammoth

Practice address

14786 S State Highway 77
Mammoth, AZ 85618-0000

Phone

(520) 487-0150

Fax

(520) 487-0156

NPI assigned

Sep 1, 2006

Last updated

Oct 17, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

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

Authorized official

Name

Barry L. Blanton

Title

Vice President

Phone

(781) 699-9000

Specialties & licenses 1

Addresses

Other names 1

• RENAL CARE GROUP - MAMMOTH Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1104928373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14786 S STATE HIGHWAY 77",
            "city": "MAMMOTH",
            "state": "AZ",
            "postal_code": "856180000",
            "telephone_number": "520-487-0150",
            "fax_number": "520-487-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14786 S STATE HIGHWAY 77",
            "city": "MAMMOTH",
            "state": "AZ",
            "postal_code": "856180000",
            "telephone_number": "520-487-0150",
            "fax_number": "520-487-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL CARE GROUP ARIZONA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-09-01",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RENAL CARE GROUP - MAMMOTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RENAL CARE GROUP - MAMMOTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pinal County Arizona
• Sun Life Family Health Center, Inc. (Sun Life Family Health Center)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mammoth, AZ
• Providers in Mammoth, AZ by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.