Total Renal Care Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lake Saint Louis, MO
NPI 1396074597 · NPPES record last updated Jul 24, 2026
Key facts
- NPI
- 1396074597
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- TOTAL RENAL CARE INC
- Practice address
- 200 Brevco PLZ
Ste 202
Lake Saint Louis, MO 63367-2950 - Phone
- (636) 625-4460
- Fax
- (636) 625-4463
- NPI assigned
- Dec 17, 2009
- Organization subpart
- No
Authorized official
- Name
- Samuel T Wey
- Title
- VP Licensure & Certification
- Phone
- (615) 341-6641
Other NPIs on the same Medicare enrollment 1
Affiliated clinicians 3
-
Piotr T Dyk, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Lake St. Louis Home At Home
- Ownership
- Profit
- Certified
- Jul 21, 2010
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 4
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2006703 | Lake St Louis at Home | Certificate of waiver | Apr 27, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100212000711 | MO | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 8426965229 | Practice locations: Lake Saint Louis, MO |
| O20100527000201 | LA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 8426965229 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Luling, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
200 Brevco PLZ
Ste 202
Lake Saint Louis, MO 63367-2950
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396074597 | Medicaid | MO |
Other names
- Lake St Louis At Home
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All providers in Lake Saint Louis, MO · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.