NPIMap

Organization Active NPI

Total Renal Care Inc

Doing business as River City Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Stillwater, MN
National Provider Identifier
1558325910
Registry record updated Feb 4, 2025
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
River City Dialysis
Practice address
1970 Northwestern Ave S
Stillwater, MN 55082-6567
Phone
(651) 430-0067
Fax
(651) 430-0140
NPI assigned
Apr 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

1970 Northwestern Ave S
Stillwater, MN 55082-6567

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
258714900MedicaidMN
42054700MedicaidWI

Other names 1

  • River City Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050315001140 MN Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Stillwater, MN

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita River City DialysisCCN 242535
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Apr 1, 1997
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.

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
24D0928604River City Dialysis1970 Northwestern Avenue North, Stillwater, MN 55082Certificate of waiverJul 19, 2027

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 23

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

View all 23

Locations

1970 Northwestern Ave S
Stillwater, MN 55082
Phone (651) 430-0067

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1558325910",
    "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": "1970 NORTHWESTERN AVE S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826567",
            "telephone_number": "651-430-0067",
            "fax_number": "651-430-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "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": "258714900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42054700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "River City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.