NPIMap

Organization Active NPI

Total Renal Care of North Carolina LLC

Doing business as Wallace Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Wallace, NC
National Provider Identifier
1396932240
Registry record updated Jun 8, 2023
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 OF NORTH CAROLINA LLC
Doing business as
Wallace Dialysis
Practice address
5650 S NC 41 Hwy
Wallace, NC 28466-6094
Phone
(910) 285-6424
Fax
(910) 285-6928
NPI assigned
Sep 25, 2007
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
John D Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

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

Addresses

Primary practice location

5650 S NC 41 Hwy
Wallace, NC 28466-6094

Mailing address

5200 Virginia Way
Brentwood, TN 37027-7569
Phone (615) 320-4593

Other identifiers 1

IdentifierTypeStateIssuer
3402659MedicaidNC

Other names 1

  • Wallace Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080717000166 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 7911815592 Practice locations: Wallace, NC

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
34D1076075Wallace Dialysis5650 S NC 41 Hwy, Wallace, NC 28466Certificate of waiverNov 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Total Renal Care of North Carolina LLC60 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1396932240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 S NC 41 HWY",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284666094",
            "telephone_number": "910-285-6424",
            "fax_number": "910-285-6928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE OF NORTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2023-06-08",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "3402659",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wallace Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wallace, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.