Kidney Health Care PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

036-121212 Issued in IL

Legal business name

KIDNEY HEALTH CARE PC

Practice address

19 Olt Ave
Pekin, IL 61554-6214

Phone

(309) 642-6705

Fax

(309) 347-2623

NPI assigned

Nov 28, 2012

Last updated

Nov 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ahsan Usman, MDNPI 1215016571

Title

Ceo

Phone

(309) 642-6705

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Pekin Dialysis LLC

  dba Tazewell County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pekin, IL
  • NPI 1619218732

  Member Of

  NPD member

Practitioners 1

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.

• Ahsan Usman, MD

  • Hospitalist Physician
  • Belleville, IL
  • NPI 1215016571

  MO

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1043555360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 OLT AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546214",
            "telephone_number": "309-642-6705",
            "fax_number": "309-347-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OLT AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546214",
            "telephone_number": "309-642-6705",
            "fax_number": "309-347-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY HEALTH CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "USMAN",
        "authorized_official_first_name": "AHSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-642-6705",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036-121212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Kellerstrass, APRN
• Rachel Lynne Kemper, B.S.
• Kyla Kenar
• Chandra Ileen Kennedy
• Mohammed Ali Khan, M.D.
• Damian Kieltyka
• Abigail Kilbride
• Jennifer Dawn King
• Jodi Knox, LCPC
• Elizabeth Koch, AU.D.

• Nephrology Physician in Pekin, IL
• Providers in Pekin, IL by specialty
• Nephrology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.