NPIMap

Organization Active NPI

Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lake Hallie, WI
National Provider Identifier
1508115395
Registry record updated Sep 3, 2024
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 INC
Doing business as
Lake Hallie Dialysis
Practice address
3636 E Melby St
Lake Hallie, WI 54729-8392
Phone
(715) 833-8512
Fax
(715) 833-8534
NPI assigned
Sep 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 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 Primary

Addresses

Primary practice location

3636 E Melby St
Lake Hallie, WI 54729-8392

Mailing address

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

Other names 1

  • Lake Hallie Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130212000052 WI Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Lake Hallie, WI

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Lake Hallie DialysisCCN 522596
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Sep 18, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Davita Upstate Dialysis758 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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1508115395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATTN: 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": "3636 E MELBY ST",
            "city": "LAKE HALLIE",
            "state": "WI",
            "postal_code": "547298392",
            "telephone_number": "715-833-8512",
            "fax_number": "715-833-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Hallie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Hallie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Hallie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.