NPIMap

Organization Active NPI

Kidney Institute of North Dakota, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grand Forks, ND
National Provider Identifier
1003809948
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
KIDNEY INSTITUTE OF NORTH DAKOTA, LLC
Practice address
1451 - 44TH Avenue South Suite 112-D
Grand Forks, ND 58201-4055
Phone
(701) 795-1300
Fax
(701) 775-5200
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

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

Authorized official

Name
Dr. Khaled Rabadi, MDNPI 1639180425
Title
Member
Phone
(701) 795-1300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ND Primary

Addresses

Primary practice location

1451 - 44TH Avenue South Suite 112-D
Grand Forks, ND 58201-4055

Mailing address

1451 - 44TH Avenue South Suite 112-D
Grand Forks, ND 58201-4055
Phone (701) 795-1300

Other identifiers 2

IdentifierTypeStateIssuer
01574MedicaidND
899627000MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030414000028 ND Part A Provider - End-Stage Renal Disease Facility (ESRD) 3072422989 Practice locations: Grand Forks, ND

National Provider Directory

National Provider Directory

Locations

5750 S Washington St
Grand Forks, ND 58201
Phone (701) 732-2819

1101 S Columbia Rd
Ste B
Grand Forks, ND 58201
Phone (701) 775-5800

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1003809948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 - 44TH AVENUE SOUTH SUITE 112-D",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014055",
            "telephone_number": "701-795-1300",
            "fax_number": "701-775-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 - 44TH AVENUE SOUTH SUITE 112-D",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014055",
            "telephone_number": "701-795-1300",
            "fax_number": "701-775-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY INSTITUTE OF NORTH DAKOTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "RABADI",
        "authorized_official_first_name": "KHALED",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "701-795-1300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01574",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899627000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.