NPIMap

Organization Active NPI

Kidney Doctors of Kentuckiana PLLC

  • Nephrology Physician
  • Jeffersonville, IN
National Provider Identifier
1073961843
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY DOCTORS OF KENTUCKIANA PLLC
Practice address
1035 Wall St Ste 103
Jeffersonville, IN 47130-3695
Phone
(812) 283-9111
Fax
(812) 283-9001
NPI assigned
Jun 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Muad A Maya, MDNPI 1558322172
Title
Owner
Phone
(812) 283-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1035 Wall St Ste 103
Jeffersonville, IN 47130-3695

Mailing address

PO Box 950195
Louisville, KY 40295-0195

Other identifiers 4

IdentifierTypeStateIssuer
201363590MedicaidIN
DW6469OtherINRAILROAD MEDICARE
7100419990MedicaidKY
50110029OtherKYPASSPORT HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160629002636 IN Part B Supplier - Clinic/Group Practice 7315239910 Receives reassigned benefits from 1 practitioner
Practice locations: Jeffersonville, IN
O20160824002874 KY Part B Supplier - Clinic/Group Practice 7315239910 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Locations

1035 Wall St
Ste 103
Jeffersonvlle, IN 47130
Phone (812) 283-9111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1073961843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950195",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 WALL ST STE 103",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303695",
            "telephone_number": "812-283-9111",
            "fax_number": "812-283-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY DOCTORS OF KENTUCKIANA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "MAYA",
        "authorized_official_first_name": "MUAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-283-9111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201363590",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DW6469",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100419990",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH PLAN",
            "identifier": "50110029",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.