NPIMap

Organization Active NPI

Total Renal Care Inc

Doing business as Fallen Timbers Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Maumee, OH
National Provider Identifier
1184078032
Registry record updated Sep 15, 2025
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
Doing business as
Fallen Timbers Dialysis
Practice address
4330 Keystone Dr
Maumee, OH 43537-8795
Phone
(419) 887-0762
Fax
(419) 887-0773
NPI assigned
Apr 18, 2016
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

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

Addresses

Primary practice location

4330 Keystone Dr
Maumee, OH 43537-8795

Mailing address

5200 Virginia Way
Att: L&C Department
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
0219352MedicaidOH

Other names 1

  • Fallen Timbers Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160816003035 OH Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Maumee, OH

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Fallen Timbers DialysisCCN 362855
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Mar 8, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

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
36D2116860Fallen Timbers Dialysis4330 Keystone Dr, Maumee, OH 43537Certificate of waiverAug 2, 2026

National Provider Directory

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

Organizations with this tax ID in the same state 15

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

View all 15

Locations

4330 Keystone Dr
Maumee, OH 43537
Phone (419) 887-0762

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": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1184078032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 KEYSTONE DR",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435378795",
            "telephone_number": "419-887-0762",
            "fax_number": "419-887-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0219352",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fallen Timbers Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fallen Timbers Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.