NPIMap

Organization Active NPI

Pensacola Nephrology, PA

Doing business as Renalus Center for Kidney Care

  • Nephrology Physician
  • Jay, FL
National Provider Identifier
1023051083
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PENSACOLA NEPHROLOGY, PA
Doing business as
Renalus Center for Kidney Care
Practice address
14114 Alabama St
Jay, FL 32565-1219
Phone
(850) 444-4700
Fax
(850) 434-8144
NPI assigned
Jun 14, 2006
Last updated
Feb 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PENSACOLA NEPHROLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Justin Dansby
Title
Cfo
Phone
(850) 444-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

14114 Alabama St
Jay, FL 32565-1219

Mailing address

PO Box 11037
Pensacola, FL 32524-1037
Phone (850) 444-4700

Other identifiers 13

IdentifierTypeStateIssuer
256870500MedicaidFL
256870506MedicaidFL
256870501MedicaidFL
256870502MedicaidFL
256870504MedicaidFL
0358OtherFLMED3000/HEALTH 1ST NETWOR
256870503MedicaidFL
256870507MedicaidFL
CF9776OtherRR MEDICARE
256870505MedicaidFL
529904030MedicaidAL
99659OtherFLBCBS OF FLORIDA
256870508MedicaidFL

Other names 1

  • Renalus Center for Kidney Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pensacola Nephrology PA15 organizations share this tax ID, including this one
Part of
Pensacola Nephrology PA

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1023051083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11037",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241037",
            "telephone_number": "850-444-4700",
            "fax_number": "850-444-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14114 ALABAMA ST",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325651219",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA NEPHROLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENSACOLA NEPHROLOGY, PA",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "DANSBY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-444-7000"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870506",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870501",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870502",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870504",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED3000/HEALTH 1ST NETWOR",
            "identifier": "0358",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870503",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870507",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CF9776",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870505",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529904030",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "99659",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870508",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renalus Center for Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renalus Center for Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.