NPIMap

Organization Active NPI

Regional Kidney Care, PC

  • Specialist
  • Kingsport, TN
National Provider Identifier
1073638144
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
REGIONAL KIDNEY CARE, PC
Practice address
2002 Brookside Drive
Suite 102
Kingsport, TN 37660-4634
Phone
(423) 245-6000
Fax
(423) 245-6062
NPI assigned
Mar 20, 2007
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Markalene Earles
Title
Practice Manager
Phone
(423) 245-6000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 021779 TN
Specialist 174400000X NU Primary

Addresses

Primary practice location

2002 Brookside Drive
Suite 102
Kingsport, TN 37660-4634

Mailing address

2002 Brookside Drive
Suite 102
Kingsport, TN 37660-4634
Phone (423) 245-6000

Other names 1

  • Kingsport Kidney Health, PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041110000356 VA Part B Supplier - Clinic/Group Practice 5597728527 Receives reassigned benefits from 7 practitioners
Practice locations: Norton, VA
O20050620000513 TN Part B Supplier - Clinic/Group Practice 5597728527 Receives reassigned benefits from 11 practitioners
Practice locations: Kingsport, TN

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
44D0862876Regional Kidney Care, PC2002 Brookside Drive Suite 102, Kingsport, TN 37660Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

2002 Brookside Dr
Ste 102
Kingsport, TN 37660
Phone (423) 245-6000

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1073638144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DRIVE",
            "address_2": "SUITE 102",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-245-6000",
            "fax_number": "423-245-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DRIVE",
            "address_2": "SUITE 102",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-245-6000",
            "fax_number": "423-245-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL KIDNEY CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "EARLES",
        "authorized_official_first_name": "MARKALENE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "423-245-6000"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "021779",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingsport Kidney Health, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Kingsport Kidney Health, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.