Organization Active NPI

Dothan Hypertension Nephrology Associates

  • Specialist
  • Dothan, AL
National Provider Identifier
1013018407
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DOTHAN HYPERTENSION NEPHROLOGY ASSOCIATES
Practice address
207 Haven Dr
Dothan, AL 36301-2919
Phone
(334) 793-3319
Fax
(334) 793-2291
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

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

Authorized official

Name
Dr. Ganjur Prakash, M.D.
Title
Owner
Phone
(334) 793-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

207 Haven Dr
Dothan, AL 36301-2919

Mailing address

207 Haven Drive
Dothan, AL 36301
Phone (334) 793-3319

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050822000909 AL Part B Supplier - Clinic/Group Practice 5991746661 Receives reassigned benefits from 14 practitioners
Practice locations: Dothan, AL

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
04D0304709Dothan Hypertension Nephrology Assoc207 Haven Drive, Dothan, AL 36301Certificate of waiverNov 28, 2027

National Provider Directory

National Provider Directory

Locations

4700 W Main St
Dothan, AL 36305

207 Haven Dr
Dothan, AL 36301
Phone (334) 793-1964

1736 E Main St
Dothan, AL 36301
Phone (334) 712-6333

220 S Orange Ave
Eufaula, AL 36027
Phone (334) 688-0806

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1013018407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HAVEN DRIVE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN HYPERTENSION NEPHROLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "PRAKASH",
        "authorized_official_first_name": "GANJUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-793-3319",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.