NPIMap

Organization Active NPI

The Kidney Care Center, LLC

Doing business as The Kidney Care Center, LLC - Lubbock

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lubbock, TX
National Provider Identifier
1801420864
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
THE KIDNEY CARE CENTER, LLC
Doing business as
The Kidney Care Center, LLC - Lubbock
The Kidney Care Center, LLC-Lubbock
Practice address
3702 Interstate 27
Lubbock, TX 79412
Phone
(806) 429-1054
Fax
(806) 256-7077
NPI assigned
Feb 28, 2020
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Shontal Carruth
Title
Billing Manager
Phone
(806) 771-0906

Specialties & licenses 1

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

Addresses

Primary practice location

3702 Interstate 27
Lubbock, TX 79412

Mailing address

1126 Slide Rd Unit 4B
Lubbock, TX 79416-5402
Phone (806) 771-0906

Other names 2

  • The Kidney Care Center, LLC - Lubbock Doing business as
  • The Kidney Care Center, LLC-Lubbock Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201111002058 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 0648423533 Practice locations: Lubbock, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Kidney Care Center LubbockCCN 742573
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Feb 3, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Other
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
The Kidney Care Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1102 Slide Rd
Ste 2
Lubbock, TX 79416
Phone (806) 771-0906

1126 Slide Rd
Unit 4B
Lubbock, TX 79416
Phone (806) 793-8447

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 4

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": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1801420864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 SLIDE RD UNIT 4B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794165402",
            "telephone_number": "806-771-0906",
            "fax_number": "806-771-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 INTERSTATE 27",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79412",
            "telephone_number": "806-429-1054",
            "fax_number": "806-256-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KIDNEY CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-28",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "CARRUTH",
        "authorized_official_first_name": "SHONTAL",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "806-771-0906"
    },
    "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": "The Kidney Care Center, LLC - Lubbock",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Kidney Care Center, LLC-Lubbock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.