NPIMap

Organization Active NPI

Tennessee Kidney Care PLLC

  • Nephrology Physician
  • Cleveland, TN
National Provider Identifier
1073963716
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
TENNESSEE KIDNEY CARE PLLC
Practice address
1060 Peerless Crossing NW
Suite 101
Cleveland, TN 37312-3785
Phone
(423) 339-3340
Fax
(423) 339-9927
NPI assigned
Jun 14, 2016
Last updated
Jan 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Authorized official

Name
Morufu Olatunji AlausaNPI 1730135955
Title
Chief Medical Director
Phone
(815) 741-6830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1060 Peerless Crossing NW
Suite 101
Cleveland, TN 37312-3785

Mailing address

PO Box 3877
Joliet, IL 60434-3877
Phone (815) 714-7171

Other practice location 1

105 Lee Parkway Dr Ste G1
Chattanooga, TN 37421-6708
Phone (423) 339-3340

Other identifiers 1

IdentifierTypeStateIssuer
Q025320MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161014000293 TN Part B Supplier - Clinic/Group Practice 2860780459 Receives reassigned benefits from 5 practitioners
Practice locations: Cleveland, TN; Chattanooga, TN; Athens, 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
44D2140488Tennessee Kidney Care105 Lee Parkway Drive Suite G1, Chattanooga, TN 37421Provider-performed microscopyNov 20, 2027

National Provider Directory

National Provider Directory

Locations

744 Tell St
Athens, TN 37303
Phone (423) 339-3340

105 Lee Parkway Dr
Ste G1
Chattanooga, TN 37421
Phone (423) 339-3340

5243 Little Debbie Pkwy
Ste 119
Ooltewah, TN 37363
Phone (423) 238-2036

5958 Snow Hill Rd
Ste 144188
Ooltewah, TN 37363

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1073963716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3877",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604343877",
            "telephone_number": "815-714-7171",
            "fax_number": "815-435-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 PEERLESS CROSSING NW",
            "address_2": "SUITE 101",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123785",
            "telephone_number": "423-339-3340",
            "fax_number": "423-339-9927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Lee Parkway Dr Ste G1",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "374216708",
            "country_code": "US",
            "telephone_number": "423-339-3340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TENNESSEE KIDNEY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A",
        "authorized_official_last_name": "ALAUSA",
        "authorized_official_first_name": "MORUFU",
        "authorized_official_middle_name": "OLATUNJI",
        "authorized_official_title_or_position": "CHIEF MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "815-741-6830"
    },
    "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": "Q025320",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.