NPIMap

Organization Active NPI

St George Kidney Care LLC

Doing business as Southern Utah Kidney and Hypertension

  • Nephrology Physician
  • St George, UT
National Provider Identifier
1134588957
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
ST GEORGE KIDNEY CARE LLC
Doing business as
Southern Utah Kidney and Hypertension
Practice address
624 S 1000 E Ste 103
St George, UT 84790-5902
Phone
(435) 652-1135
Fax
(435) 652-1190
NPI assigned
Feb 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Ryan Valle
Title
President
Phone
(781) 699-9362

Specialties & licenses 1

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

Addresses

Primary practice location

624 S 1000 E Ste 103
St George, UT 84790-5902

Mailing address

624 S 1000 E Ste 103
St George, UT 84790-5902
Phone (435) 652-1135

Other practice location 1

1320 N Main St Ste 103
Cedar City, UT 84721-1230
Phone (435) 652-1135

Other identifiers 1

IdentifierTypeStateIssuer
3001772MedicaidUT

Other names 1

  • Southern Utah Kidney and Hypertension Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160623002390 UT Part B Supplier - Clinic/Group Practice 2567753460 Receives reassigned benefits from 10 practitioners
Practice locations: St George, UT; Cedar City, UT

National Provider Directory

National Provider Directory

Locations

1320 N Main St
Ste 103
Cedar City, UT 84721
Phone (435) 586-1276

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1134588957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 S 1000 E STE 103",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905902",
            "telephone_number": "435-652-1135",
            "fax_number": "435-652-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 S 1000 E STE 103",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905902",
            "telephone_number": "435-652-1135",
            "fax_number": "435-652-1190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 N Main St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Cedar City",
            "state": "UT",
            "postal_code": "847211230",
            "country_code": "US",
            "telephone_number": "435-652-1135",
            "fax_number": "435-652-1190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST GEORGE KIDNEY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-22",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "VALLE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-699-9362"
    },
    "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": "3001772",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Utah Kidney and Hypertension",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.