Associated Nephrology Consultants, P.a.
Organization Active NPI Nephrology Physician · Maplewood, MN
NPI 1104976158 · NPPES record last updated Oct 25, 2022
Key facts
- NPI
- 1104976158
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- ASSOCIATED NEPHROLOGY CONSULTANTS, P.A.
- Practice address
- 1997 Sloan PL Ste 17
Maplewood, MN 55117-2051 - Phone
- (651) 772-6251
- Fax
- (651) 224-9661
- NPI assigned
- Jan 11, 2007
- Organization subpart
- No
Authorized official
- Name
- Shannon Elizabeth Doyle, MD
- Title
- Owner Ceo
- Phone
- (651) 772-6251
Practitioners 20
-
Maryyam Ali, M.D.
-
Jennifer L Mears, RN, CNP
-
Alec David Otteman, M.D.
-
Nyan Pyae, M.D.
-
Amy Beth Sibley, CNP
-
Cara Sue Walz, MD
-
Megan Lee Washek, PA
-
Stephanie Jo Niklaus, ANP-BC
-
Mary K Schmidt, FNP
-
David Hugh Warden, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D1103593 | Associated Nephrology Consultants | Provider-performed microscopy | Aug 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090827000310 | MN | Part B Supplier - Clinic/Group Practice | 7214004068 |
Receives reassigned benefits from 19 practitioners Practice locations: Hastings, MN; Maplewood, MN |
National Provider Directory
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/3y297hHso-SAgtaVMIScpv67gSH7SYy3/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | MN | Yes |
Addresses
Primary practice location
1997 Sloan PL Ste 17
Maplewood, MN 55117-2051
Mailing address
2854 Highway 55
Suite 130
Eagan, MN 55121-1447
Phone (651) 842-3378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223012700 | Medicaid | MN |
Other providers in Maplewood, MN
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- Carrie L. Ardolf
- Korry Arndt-Wenger
- Jennifer Arnold
- Associated Dialysis Consultants LLC
- Assured Kare Consultation Inc.
- Jacqueline Rebecca Aufderhar
- Bradley E Austin
- Autism Institute of Minnesota LLP
- Avalon Ramsey
All providers in Maplewood, MN · Nephrology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.