NPIMap

Individual provider Active NPI

Julio Ernesto Pena, M.D.

  • Nephrology Physician
  • Watkinsville, GA
National Provider Identifier
1073891198
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
75119 Issued in GA
Practice address
1360 Caduceus Way
BLDG 400, Suite 104
Watkinsville, GA 30677-7300
Phone
(706) 850-8135
Fax
(706) 548-9101
NPI assigned
Jul 22, 2011
Last updated
Jul 18, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

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 75119 GA Primary

Addresses

Primary practice location

1360 Caduceus Way
BLDG 400, Suite 104
Watkinsville, GA 30677-7300

Mailing address

1360 Caduceus Way
BLDG 400, Suite 104
Watkinsville, GA 30677-7300
Phone (706) 850-8135

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20160726002622 GA Practitioner - NephrologyPractitioner - Internal Medicine 5294028429 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgia Kidney Consultants LLCGroup PAC ID 4284820705, 3 clinicians

Practice addresses (Care Compare)

1360 Caduceus
Suite 104
Watkinsville, GA 30677-7351

1360 Caduceus Way
BLDG 400 104
Watkinsville, GA 30677-7351
Phone (706) 850-8135

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Kidney Consultants, LLC Nephrology CurrentSince Jul 18, 2016 Accepting new patients

Locations

1360 Caduceus Way
Bldg 400
Watkinsville, GA 30677
Phone (706) 286-8442

1360 Caduceus Way
Bldg 400-104
Watkinsville, GA 30677
Phone (706) 850-8135

Organizations & group practices 1

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 10

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": "1311292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468800000000",
    "number": "1073891198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY",
            "address_2": "BLDG 400, SUITE 104",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777300",
            "telephone_number": "706-850-8135",
            "fax_number": "706-548-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 CADUCEUS WAY",
            "address_2": "BLDG 400, SUITE 104",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777300",
            "telephone_number": "706-850-8135",
            "fax_number": "706-548-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "JULIO",
        "middle_name": "ERNESTO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-22",
        "last_updated": "2016-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "75119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watkinsville, GA

Sources for this page

Verify at the official NPI Registry.