NPIMap

Individual provider Active NPI

Marwan A Takieddine, M.D.

  • Nephrology Physician
  • Las Vegas, NV
National Provider Identifier
1023099132
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
7063 Issued in NV
Practice address
2450 Fire Mesa St Ste 110
Las Vegas, NV 89128-9034
Phone
(702) 853-0090
Fax
(702) 853-0096
NPI assigned
Nov 7, 2005
Last updated
May 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 7063 NV Primary

Addresses

Primary practice location

2450 Fire Mesa St Ste 110
Las Vegas, NV 89128-9034

Mailing address

2545 S Bruce St Ste 200
Las Vegas, NV 89169-1778
Phone (702) 732-2438

Other identifiers 3

IdentifierTypeStateIssuer
002019634MedicaidNV
347064MedicaidAZ
1023099132MedicaidNV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtakieddine35806@direct.acumenmd.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101105000330 NV Practitioner - NephrologyPractitioner - Internal Medicine 2567492002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nkdhc Rudnitsky PLLCGroup PAC ID 1557582210, 44 clinicians

Practice addresses (Care Compare)

2450 Fire Mesa St
Suite 110
Las Vegas, NV 89128-9034
Phone (702) 853-0090

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Valley Medical Center Past Accepting new patients
Nkdhc Rudnitsky PLLC Nephrology Past Accepting new patients
Dignity Health Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Boulder City Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mtakieddine35806@direct.acumenmd.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1023099132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 S BRUCE ST STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891691778",
            "telephone_number": "702-732-2438",
            "fax_number": "702-737-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 FIRE MESA ST STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289034",
            "telephone_number": "702-853-0090",
            "fax_number": "702-853-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKIEDDINE",
        "first_name": "MARWAN",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NV",
            "license": "7063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002019634",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347064",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023099132",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtakieddine35806@direct.acumenmd.com",
            "affiliation": "N",
            "address_1": "2450 Fire Mesa St Ste 110",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891289034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.