NPIMap

Organization Active NPI

Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Palatka, FL
National Provider Identifier
1124378518
Registry record updated Aug 25, 2023
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
Practice address
326 Zeagler Dr
Palatka, FL 32177-3817
Phone
(386) 329-9458
Fax
(386) 329-9340
NPI assigned
Sep 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Samuel T. Wey, AO
Title
Sr Director Licensure&Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

326 Zeagler Dr
Palatka, FL 32177-3817

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 1

IdentifierTypeStateIssuer
008713900MedicaidFL

Other names 1

  • Palatka Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121205000461 FL Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Palatka, FL

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Palatka DialysisCCN 682532
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Feb 18, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
16

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
10D2052506Palatka Dialysis326 Zeagler Dr, Palatka, FL 32177Certificate of waiverJan 10, 2027

National Provider Directory

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

Organizations with this tax ID in the same state 20

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

View all 20

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": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1124378518",
    "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",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773817",
            "telephone_number": "386-329-9458",
            "fax_number": "386-329-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "SR DIRECTOR LICENSURE&CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641",
        "authorized_official_credential": "AO"
    },
    "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": "008713900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palatka Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palatka Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palatka, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.