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

Practice address

14852 Scenic Heights Rd Ste 255
BLDG B
Eden Prairie, MN 55344-2320

Phone

(952) 934-2411

Fax

(952) 934-3851

NPI assigned

Apr 13, 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 1

Other names 1

• Eden Prairie Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

DaVita Eden Prairie DialysisCCN 242556

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Oct 6, 2003

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 2

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
  • Richfield, MN
  • NPI 1083678445
  NPD tax ID
• Renal Treatment Centers-Illinois Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • St Louis Park, MN
  • NPI 1447214812
  NPD tax ID

Locations

Affiliated clinicians 2

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

• George Thomas O'Bryan, M.D.

  • Nephrology Physician
  • Edina, MN
  • NPI 1417061904

  Dialysis facility

  Care Compare affiliation Name & address match
• Abel Ernesto Tello Jr., M.D.

  • Nephrology Physician
  • St Louis Park, MN
  • NPI 1043276207

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1962466441",
    "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": "14852 SCENIC HEIGHTS RD STE 255",
            "address_2": "BLDG B",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442320",
            "telephone_number": "952-934-2411",
            "fax_number": "952-934-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "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": "488935500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Prairie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eden Prairie Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan-Erle Christian Reid
• Andrea Reinardy
• Amber Reis, LMFT
• Reliable Ride LLC
• Karissa Remer
• Renewal MN LLC
• Rachel Rhyner
• Lionel Wayne Rice Jr., ATC
• Mavis Rice, MA LP
• Mariah Richards-Maynard, MFT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.