NPIMap

Organization Active NPI

Total Renal Care Inc

Doing business as Black Canyon Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Montrose, CO
National Provider Identifier
1891011623
Registry record updated Aug 5, 2024
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
Black Canyon Dialysis
Practice address
3421 S Rio Grande Ave
Unit D1
Montrose, CO 81401-4840
Phone
(970) 240-7925
Fax
(970) 240-6197
NPI assigned
Apr 19, 2010
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

3421 S Rio Grande Ave
Unit D1
Montrose, CO 81401-4840

Mailing address

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

Other names 1

  • Black Canyon Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100609000638 CO Part A Provider - End-Stage Renal Disease Facility (ESRD) 8426965229 Practice locations: Montrose, CO

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Black Canyon DialysisCCN 062569
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Oct 15, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
13

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
06D2012494Black Canyon Davita Dialysis3421 Rio Grande Ave, Unit D, Montrose, CO 81401Certificate of waiverSep 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Springdale Dialysis758 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

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

Practitioners & affiliated clinicians

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": "1271635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1891011623",
    "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": "3421 S RIO GRANDE AVE",
            "address_2": "UNIT D1",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814014840",
            "telephone_number": "970-240-7925",
            "fax_number": "970-240-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-19",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "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": "Black Canyon Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Canyon Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montrose, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.