Organization Active NPI

Total Renal Laboratories Inc

Doing business as DaVita Labs

Clinical Medical Laboratory
Deland, FL

National Provider Identifier

1245720820

Registry record updated Aug 28, 2024

On this page

Key facts
NPPES NPI Registry
Medicare participation
Laboratory certificates & supplier records
National Provider Directory
Ownership & related parties
NPI Registry JSON
Other providers in Deland, FL
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
License: 800005025 Issued in FL
Legal business name: TOTAL RENAL LABORATORIES INC
Doing business as: DaVita Labs
Practice address: 3000 Davita Way
Deland, FL 32724
Phone: (386) 626-5700
Fax: (386) 626-5638
NPI assigned: May 18, 2018
Last updated: Aug 28, 2024By the provider in NPPES
Organization subpart: Yes
Parent organization: TOTAL RENAL CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name: Keri Wagner
Title: VP - General Manager
Phone: (386) 626-5700

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X	800005025	FL	Primary

Addresses

Primary practice location

3000 Davita Way
Deland, FL 32724

Mailing address

PO Box 100244
Atlanta, GA 30384-0244
Phone (386) 626-5700

Other identifiers 44

Identifier	Type	State
0015880660004	Medicaid	PA
0326359	Medicaid	OH
081833728	Medicaid	DC
100758080B	Medicaid	OK
1245720820	Medicaid	ID
1245720820	Medicaid	NC
1245720820	Medicaid	CA
1245720820	Medicaid	CO
3010008	Medicaid	UT
3995045-01	Medicaid	TX
04402709	Medicaid	MS
101245100	Medicaid	FL
110148599A	Medicaid	MA
1245720820	Medicaid	MN
1477612	Medicaid	ND
228520	Medicaid	AL
232372709	Medicaid	AR
300022760	Medicaid	IN
1245720820	Medicaid	WV
2124491	Medicaid	WA
283981402	Medicaid	MD
3118922	Medicaid	NH
500761736	Medicaid	OR
0412083	Medicaid	IA
1245720820	Medicaid	WY
1245720820	Medicaid	WI
0706493	Medicaid	NJ
1245720820	Medicaid	MI
1245720820	Medicaid	CT
1245720820	Medicaid	VA
38436361	Medicaid	NM
7100581410	Medicaid	KY
L00677	Medicaid	SC
Q069472	Medicaid	TN
30003947130002	Medicaid	KS
003214508A	Medicaid	GA
02244535	Medicaid	NY
10026760900	Medicaid	NE
1245720820	Medicaid	SD
2488171	Medicaid	LA
1245720820	Medicaid	MT
1245720820	Medicaid	ME
504222	Medicaid	AZ
700066284	Medicaid	MO

Other names 1

DaVita Labs Doing business as

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in FL

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20080216000053	FL	Part B Supplier - Independent Clinical Laboratory	3476636226	1 other NPI on this enrollment Practice locations: Deland, FL

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 number	Laboratory	Certificate	Expires
10D2154944	Total Renal Laboratories Inc Dba Davita Labs3000 Davita Way, Deland, FL 32724	Accreditation	Jun 4, 2027

National Provider Directory

Part of: Springdale Dialysis

Locations

3000 Davita Way
Deland, FL 32724
Phone (386) 626-5700

402683 Lockbox
Atlanta, GA 30384

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facility	Type	Role	Since
Altenheim Health & Living CommunityIndianapolis, IN, CCN 155196	Skilled nursing facility	Adp of the SNF	Jul 16, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Riverview Hospital

dba Altenheim Health & Living
- Skilled Nursing Facility
- Indianapolis, IN
- NPI 1710205141
Adp of the SNF
CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1245720820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100244",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840244",
            "telephone_number": "386-626-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 DAVITA WAY",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "32724",
            "telephone_number": "386-626-5700",
            "fax_number": "386-626-5638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL LABORATORIES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TOTAL RENAL CARE INC",
        "enumeration_date": "2018-05-18",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "KERI",
        "authorized_official_title_or_position": "VP - GENERAL MANAGER",
        "authorized_official_telephone_number": "386-626-5700"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
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            "license": "800005025",
            "primary": true
        }
    ],
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    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Labs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DaVita Labs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deland, FL

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
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.