NPIMap

Organization Active NPI

Total Renal Care Inc

Doing business as Mississippi Gateway Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Coon Rapids, MN
National Provider Identifier
1861456337
Registry record updated Oct 13, 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
Mississippi Gateway Dialysis
Practice address
3960 Coon Rapids Blvd NW Ste 309
Coon Rapids, MN 55433-2589
Phone
(763) 421-8717
Fax
(763) 421-4789
NPI assigned
Apr 13, 2006
Last updated
Oct 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 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

3960 Coon Rapids Blvd NW Ste 309
Coon Rapids, MN 55433-2589

Mailing address

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

Other names 2

  • Mississippi Gateway Dialysis Doing business as
  • Coon Rapids Dialysis Unit Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080114000142 MN Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Coon Rapids, MN

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Mississippi Gateway DialysisCCN 242514
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jan 25, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
16

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
24D0691356Mississippi Gateway Dialysis3960 Coon Rapids Blvd Ste 309, Coon Rapids, MN 55433Certificate of waiverJul 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hernando Kidney Center758 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

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

View all 15

Locations

3960 Coon Rapids Blvd NW
Ste 309
Coon Rapids, MN 55433
Phone (763) 421-8717

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1760313600000",
    "number": "1861456337",
    "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": "3960 COON RAPIDS BLVD NW STE 309",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332589",
            "telephone_number": "763-421-8717",
            "fax_number": "763-421-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "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": "Mississippi Gateway Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coon Rapids Dialysis Unit",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.