Maple Grove Dialysis LLC

Primary specialty

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

Legal business name

MAPLE GROVE DIALYSIS LLC

Doing business as

Maple Grove Dialysis Unit

Practice address

15655 Grove Cir N
Maple Grove, MN 55369-4489

Phone

(763) 420-2804

Fax

(763) 420-7162

NPI assigned

Jan 22, 2008

Last updated

Apr 11, 2025By the provider in NPPES

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

• Maple Grove Dialysis Unit Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

DaVita Maple Grove Dialysis UnitCCN 242571

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 3, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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 3

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

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member
• Total Renal Care Inc

  dba Kenwood Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1831896364

  Member Of

  NPD member
• Total Renal Care, Inc.

  dba Bountiful Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bountiful, UT
  • NPI 1184387516

  Member Of

  NPD member

Locations

Affiliated clinicians 5

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

• Eric C Chen, MD

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1235323247

  Dialysis facility

  Care Compare affiliation Name & address match
• Juliet Gatiba

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1578069985

  Dialysis facility

  Care Compare affiliation Name & address match
• Michael Grant Somermeyer, M.D.

  • Nephrology Physician
  • Brooklyn Center, MN
  • NPI 1023038981

  Dialysis facility

  Care Compare affiliation Name & address match
• Mary Tahnk-Johnson

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1548247547

  Dialysis facility

  Care Compare affiliation Name & address match
• Katti Lauren Woerner, D.O

  • Nephrology Physician
  • Maple Grove, MN
  • NPI 1043486590

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744329600000",
    "number": "1255518247",
    "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": "15655 GROVE CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694489",
            "telephone_number": "763-420-2804",
            "fax_number": "763-420-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "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": "1255518247",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Grove Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Grove Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roger L Mann
• Dianne Marie Mansfield, PT
• Maple Grove Center for Restorative Surgery
• Maple Grove Center for Restorative Surgery LLC
• Maple Grove Counseling Center PA
• Maple Grove Eye Care, LLC
• Maple Grove Family Dental Clinic, PA
• Maple Grove Hospital Corporation
• Maple Grove Hospital Corporation (Maple Grove Overnight Discharge Pharmacy)
• Maple Grove Periodontics and Implant Dentistry

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.