NPIMap

Organization Active NPI

Renal Treatment Centers-Illinois Inc.

Doing business as Park Plaza Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Flint, MI
National Provider Identifier
1376505552
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
RENAL TREATMENT CENTERS-ILLINOIS INC.
Doing business as
Park Plaza Dialysis
Practice address
G1075 N Ballenger Hwy
Flint, MI 48504-4431
Phone
(810) 235-8468
Fax
(810) 235-9144
NPI assigned
Apr 4, 2006
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

G1075 N Ballenger Hwy
Flint, MI 48504-4431

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
4620087MedicaidMI

Other names 1

  • Park Plaza Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030714000060 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 2365359965 Practice locations: Flint, MI

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers - Illinois Inc85 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

Locations

G1075 N Ballenger Hwy
Flint, MI 48504
Phone (810) 235-8468

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1376505552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "G1075 N BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485044431",
            "telephone_number": "810-235-8468",
            "fax_number": "810-235-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-ILLINOIS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-10",
        "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": "4620087",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Plaza Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park Plaza Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.