NPIMap

Organization Active NPI

Renal Care Group of the Midwest, Inc.

Doing business as Renal Care of Poplar Bluff

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1114039088
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
RENAL CARE GROUP OF THE MIDWEST, INC.
Doing business as
Renal Care of Poplar Bluff
Practice address
2311 Eugene Blvd
Poplar Bluff, MO 63901-2397
Phone
(573) 785-5000
Fax
(573) 785-5005
NPI assigned
Aug 31, 2006
Last updated
Oct 16, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

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

Addresses

Primary practice location

2311 Eugene Blvd
Poplar Bluff, MO 63901-2397

Mailing address

2311 Eugene Blvd
Poplar Bluff, MO 63901-2397
Phone (573) 785-5000

Other names 1

  • RENAL CARE OF POPLAR BLUFF Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324000037 MO Part A Provider - End-Stage Renal Disease Facility (ESRD) 8527979178 Practice locations: Poplar Bluff, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114039088. Details of each certification follow.

  • CCN 262563 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 262563

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Fresenius Medical Care - Poplar Bluff
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
May 28, 1998
Last certification
Jul 27, 2022
Ownership / control type
For Profit
Multi-facility organization
Fresenius Medical Care Holdings, Inc.
Facility address
2311 Eugene Boulevard
Poplar Bluff, MO 63901

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Osteoporosis Detection8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 25

Organizations listed as members of this organization in the National Provider Directory.

View all 25

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1114039088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 EUGENE BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012397",
            "telephone_number": "573-785-5000",
            "fax_number": "573-785-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 EUGENE BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012397",
            "telephone_number": "573-785-5000",
            "fax_number": "573-785-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL CARE GROUP OF THE MIDWEST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "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 OF POPLAR BLUFF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.