Renal Care Group Chicago Southside, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

RENAL CARE GROUP CHICAGO SOUTHSIDE, LLC

Practice address

11630 S Kedzie Ave
Merrionette Park, IL 60803-6302

Phone

(708) 389-9099

Fax

(708) 389-9088

NPI assigned

Oct 13, 2006

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

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

Authorized official

Name

Denise Wright

Title

Vice President

Phone

(781) 676-5200

Specialties & licenses 1

Addresses

Other names 1

• RENAL CARE GROUP MERRIONETTE PARK Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

FMC - Merrionette ParkCCN 142667

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 11, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Fresenius Medical Care

Dialysis stations

24

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Dialysis Centers of America - Illinois, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1700991551

  Member Of

  NPD member

Affiliated clinicians 4

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

• Goutham Kondapi

  • Nephrology Physician
  • Evergreen Park, IL
  • NPI 1245792175

  Dialysis facility

  Care Compare affiliation Name & address match
• Ejikeme O Obasi, MD

  • Nephrology Physician
  • Evergreen Park, IL
  • NPI 1205869815

  Dialysis facility

  Care Compare affiliation Name & address match
• Amishi Patel, MD

  • Nephrology Physician
  • Evergreen Park, IL
  • NPI 1063670719

  Dialysis facility

  Care Compare affiliation Name & address match
• George Sousanieh, MD

  • Nephrology Physician
  • Evergreen Park, IL
  • NPI 1033514625

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1710077219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11630 S KEDZIE AVE",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608036302",
            "telephone_number": "708-389-9099",
            "fax_number": "708-389-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11630 S KEDZIE AVE",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608036302",
            "telephone_number": "708-389-9099",
            "fax_number": "708-389-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL CARE GROUP CHICAGO SOUTHSIDE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-10-13",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-676-5200"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RENAL CARE GROUP MERRIONETTE PARK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacqueline Anai Potter, MHP
• Premier Cardiac Surgery Center, PLLC
• Premier Vascular, LLC
• Providers Medical Imaging and Management
• Jalisa Ramirez
• Semira Roberts
• Dierra Grace Robinson
• Ebony Robinson
• Lauren Robinson
• Yolanda Roland

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Merrionette Park, IL
• Providers in Merrionette Park, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; 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.