NPIMap

Organization Active NPI

Total Renal Care of North Carolina LLC

Doing business as Southport Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Southport, NC
National Provider Identifier
1881832038
Registry record updated Feb 19, 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 OF NORTH CAROLINA LLC
Doing business as
Southport Dialysis Center
Practice address
1513 N Howe St
Ste 15
Southport, NC 28461-2770
Phone
(910) 454-0273
Fax
(910) 454-0277
NPI assigned
Jan 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Samuel 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

1513 N Howe St
Ste 15
Southport, NC 28461-2770

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
3402669MedicaidNC

Other names 1

  • Southport Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090615000423 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 7911815592 Practice locations: Southport, NC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Southport Dialysis CenterCCN 342669
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Jul 23, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
11

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
34D1095883Southport Dialysis Center1513 Howe St Ste 15, Southport, NC 28461Certificate of waiverFeb 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Total Renal Care of North Carolina LLC60 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

Member of 1

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

Locations

1513 N Howe St
Ste 15
Southport, NC 28461
Phone (910) 454-0272

1513 N Howe St
Southport, NC 28461
Phone (910) 454-8030

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": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1881832038",
    "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": "1513 N HOWE ST",
            "address_2": "STE 15",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284612770",
            "telephone_number": "910-454-0273",
            "fax_number": "910-454-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE OF NORTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-27",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "3402669",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southport Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southport Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southport, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.