SRS-Ely LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

SRS-ELY LLC

Practice address

701 East 15TH Street
Ely, NV 89301

Phone

(615) 467-0140

Fax

(615) 259-0693

NPI assigned

Nov 19, 2013

Last updated

Nov 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerome Seymour Tannenbaum, M.D.,PHS, FACPNPI 1346485638

Title

President

Phone

(615) 467-0140

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Practitioners 2

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.

• Jerome Seymour Tannenbaum, M.D., PH.D.

  • Nephrology Physician
  • Nashville, TN
  • NPI 1346485638
  Authorized official Same address or phone
• Peter Clark, M.D.

  • Nephrology Physician
  • Reno, NV
  • NPI 1821106709
  NPD (past)

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1144650722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198813",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372198813",
            "telephone_number": "615-467-0140",
            "fax_number": "615-259-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 EAST 15TH STREET",
            "city": "ELY",
            "state": "NV",
            "postal_code": "89301",
            "telephone_number": "615-467-0140",
            "fax_number": "615-259-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRS-ELY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-19",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "TANNENBAUM",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "SEYMOUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-467-0140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,PHS, FACP"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy Sue Schaefer
• Gary M Seigel, M.D.
• Shannon Michael Sena, DDS
• Angel Ladeane Smith, PHARM D.
• Austin L Sorensen, MSW
• State of Nevada (Ely Mental Health Center)
• State of Nevada (Ely Mental Health Center)
• Steptoe Drug Inc
• Summit Therapy Services LLC
• Nasir Uddin, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ely, NV
• Providers in Ely, NV by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.