NPIMap

Organization Active NPI

Kidney Specialists, Inc.

Doing business as Kidney Specialists

  • Nephrology Physician
  • Westerville, OH
National Provider Identifier
1124038963
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY SPECIALISTS, INC.
Doing business as
Kidney Specialists
Practice address
595 Copeland Mill Rd
Suite 2D
Westerville, OH 43081-8908
Phone
(614) 823-8500
Fax
(614) 823-8501
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Authorized official

Name
Dr. William A Wilmer, MDNPI 1750380481
Title
President
Phone
(614) 823-8500

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 OH Primary

Addresses

Primary practice location

595 Copeland Mill Rd
Suite 2D
Westerville, OH 43081-8908

Mailing address

595 Copeland Mill Rd
Suite 2D
Westerville, OH 43081-8908
Phone (614) 823-8500

Other identifiers 5

IdentifierTypeStateIssuer
2411303MedicaidOH
2436055MedicaidOH
2446884MedicaidOH
2436082MedicaidOH
2436117MedicaidOH

Other names 1

  • Kidney Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000294 OH Part B Supplier - Clinic/Group Practice 7719871474 Receives reassigned benefits from 8 practitioners
Practice locations: Logan, OH; Newark, OH; Pataskala, OH; Pickerington, OH; Westerville, OH; Lancaster, OH; Columbus, OH

National Provider Directory

National Provider Directory

Locations

1303 Olentangy River Rd
Unit 100
Columbus, OH 43212
Phone (614) 294-5757

750 Mount Carmel Mall
#380
Columbus, OH 43222
Phone (614) 823-8500

1550 Sheridan Dr
#103
Lancaster, OH 43130
Phone (740) 475-0058

8050 E Main St
Reynoldsburg, OH 43068
Phone (614) 355-8160

595 Copeland Mill Rd
Ste 2D
Westerville, OH 43081
Phone (614) 823-8500

495 Cooper Rd
Ste 425
Westerville, OH 43081
Phone (614) 895-4980

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443052800000",
    "number": "1124038963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 COPELAND MILL RD",
            "address_2": "SUITE 2D",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818908",
            "telephone_number": "614-823-8500",
            "fax_number": "614-823-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 COPELAND MILL RD",
            "address_2": "SUITE 2D",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430818908",
            "telephone_number": "614-823-8500",
            "fax_number": "614-823-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2015-09-24",
        "status": "A",
        "authorized_official_last_name": "WILMER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-823-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2411303",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2436055",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2446884",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2436082",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2436117",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kidney Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2015; 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.