Renal Treatment Centers-Illinois Inc

Primary specialty

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

Legal business name

RENAL TREATMENT CENTERS-ILLINOIS INC

Doing business as

Crestwood Dialysis

Practice address

9560 Watson Rd Ste a
Saint Louis, MO 63126-1541

Phone

(314) 842-0322

Fax

(314) 842-0351

NPI assigned

Mar 31, 2006

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• Crestwood Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

DaVita Crestwood DialysisCCN 262591

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Mar 18, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

12

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

CLIA laboratory certificates

Tax ID family

Renal Treatment Centers - Illinois Inc85 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

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

• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1073574794
  NPD tax ID
• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Columbia, MO
  • NPI 1629039300
  NPD tax ID
• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1649210824
  NPD tax ID
• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kennett, MO
  • NPI 1770545725
  NPD tax ID
• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Festus, MO
  • NPI 1801858857
  NPD tax ID
• Renal Treatment Centers-Illinois Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1942261482
  NPD tax ID

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1841251535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "9560 WATSON RD STE A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631261541",
            "telephone_number": "314-842-0322",
            "fax_number": "314-842-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "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": "=========",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507297208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestwood Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crestwood Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yingjie Ren
• Zhen Ren, MD
• Renal Alliance, LLC
• Renal Treatment Centers-Illinois Inc
• Renal Treatment Centers-Illinois Inc
• Renal Treatment Centers-Illinois Inc
• Renalcare LLC
• Olivia Renard
• Allison Brouillet Renaud, PA
• Linda Renaud

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.