Loup Dialysis LLC

Primary specialty

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

Legal business name

LOUP DIALYSIS LLC

Practice address

1011 Bowles Ave
Ste 210
Fenton, MO 63026-2384

Phone

(636) 326-7130

Fax

(636) 326-8011

NPI assigned

Jun 21, 2011

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

• Bowles Avenue Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

DaVita Bowles Avenue DialysisCCN 262649

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Feb 29, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

14

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 7

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

• Alexis Chris Argoudelis, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1639270002

  Dialysis facility

  Care Compare affiliation Name & address match
• Ameesh Dara, D.O.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1417367244

  Dialysis facility

  Care Compare affiliation Name & address match
• Tingting Li, MD

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1831154053

  Dialysis facility

  Care Compare affiliation Name & address match
• Bruce Jeffrey Lippmann, MD

  • Nephrology Physician
  • Creve Coeur, MO
  • NPI 1346330081

  Dialysis facility

  Care Compare affiliation Name & address match
• Margaret Meier, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1659723963

  Dialysis facility

  Care Compare affiliation Name & address match
• Maisa A Nazzal, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1295991073

  Dialysis facility

  Care Compare affiliation Name & address match
• Nabil H Tauk, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1447237904

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1154617892",
    "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": "1011 BOWLES AVE",
            "address_2": "STE 210",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262384",
            "telephone_number": "636-326-7130",
            "fax_number": "636-326-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUP DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "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": "1154617892",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bowles Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bowles Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Luxottica of America Inc.

• All providers in Fenton, MO
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.