TRC - Indiana LLC

Primary specialty

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

Legal business name

TRC - INDIANA LLC

Doing business as

Comprehensive Renal Care Gary

Practice address

4802 Broadway
Gary, IN 46408-4509

Phone

(219) 887-1199

Fax

(219) 887-1605

NPI assigned

Apr 11, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Comprehensive Renal Care Gary Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 7

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

• TRC - Indiana LLC

  dba Merrillville Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Merrillville, IN
  • NPI 1124082680

  8729998109

  Same PAC ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Hammond

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hammond, IN
  • NPI 1215990965

  8729998109

  Same PAC ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care East Chicago

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • East Chicago, IN
  • NPI 1578526216

  8729998109

  Same PAC ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Michigan City

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Michigan City, IN
  • NPI 1659334431

  8729998109

  Same PAC ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Munster

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Munster, IN
  • NPI 1699738484

  8729998109

  Same PAC ID
• TRC - Indiana LLC

  dba Tell City Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tell City, IN
  • NPI 1982668455

  8729998109

  Same PAC ID
• TRC - Indiana, LLC

  dba Comprehensive Renal Care Valparaiso

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Valparaiso, IN
  • NPI 1457314171

  8729998109

  Same PAC ID

Listed as

DaVita Comprehensive Renal Care - GaryCCN 152521

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Jul 30, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

40

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

TRC - Indiana LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

• TRC - Indiana LLC

  dba Merrillville Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Merrillville, IN
  • NPI 1124082680
  NPD tax ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Hammond

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hammond, IN
  • NPI 1215990965
  NPD tax ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care East Chicago

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • East Chicago, IN
  • NPI 1578526216
  NPD tax ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Michigan City

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Michigan City, IN
  • NPI 1659334431
  NPD tax ID
• TRC - Indiana LLC

  dba Comprehensive Renal Care Munster

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Munster, IN
  • NPI 1699738484
  NPD tax ID
• TRC - Indiana LLC

  dba Tell City Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tell City, IN
  • NPI 1982668455
  NPD tax ID
• TRC - Indiana, LLC

  dba Comprehensive Renal Care Valparaiso

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Valparaiso, IN
  • NPI 1457314171
  NPD tax ID

Member of 2

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

• Renal Treatment Centers-Illinois Inc

  dba Kankakee County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bourbonnais, IL
  • NPI 1073675138

  Member Of

  NPD member
• Total Renal Care Inc

  dba Cascade Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Raied Abdullah, M.D.

  • Nephrology Physician
  • Gary, IN
  • NPI 1063417657

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1952364648",
    "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": "4802 BROADWAY",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464084509",
            "telephone_number": "219-887-1199",
            "fax_number": "219-887-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRC - INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "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": "200315330A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Renal Care Gary",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Comprehensive Renal Care Gary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Gary, IN
• Providers in Gary, IN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.