NPIMap

Organization Active NPI

North Texas Kidney Disease Associates

  • Nephrology Physician
  • Carrollton, TX
National Provider Identifier
1154777068
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Practice address
4333 N Josey LN Ste 103
Carrollton, TX 75010-4620
Phone
(972) 219-0558
Fax
(972) 436-9273
NPI assigned
May 10, 2016
Organization subpart
Yes
Parent organization
NORTH TEXAS KIDNEY DISEASE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Sirena Martin
Title
Practice Manager
Phone
(214) 466-7230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

4333 N Josey LN Ste 103
Carrollton, TX 75010-4620

Mailing address

1600 Waters Ridge Dr Ste a
Lewisville, TX 75057-6039
Phone (972) 219-0558

Other identifiers 1

IdentifierTypeStateIssuer
146883702MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001106 TX Part B Supplier - Clinic/Group Practice 0941296107 Receives reassigned benefits from 26 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plano, TX; North Richland Hills, TX; Lewisville, TX; Frisco, TX; Fort Worth, TX; Flower Mound, TX; Denton, TX; Carrollton, TX…

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
45D2107825North Texas Kidney Disease Associates4333 N Josey Lane Suite 202, Carrollton, TX 75010Certificate of waiverJan 21, 2028

National Provider Directory

National Provider Directory
Part of
North TX Kidney Disease

Locations

4240 International Pkwy
Ste 154
Carrollton, TX 75007
Phone (469) 574-0464

4312 Heritage Trace Pkwy
Ste 708
Fort Worth, TX 76244
Phone (817) 380-4167

919 Alston Ave
Ste 101
Fort Worth, TX 76104
Phone (817) 870-9941

10700 Victoria Ash Dr
Fort Worth, TX 76244
Phone (817) 283-5166

6300 W Parker Rd
Ste 224
Plano, TX 75093
Phone (469) 574-0464

1220 Coit Rd
Ste 107
Plano, TX 75075
Phone (972) 295-9660

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1154777068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WATERS RIDGE DR STE A",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576039",
            "telephone_number": "972-219-0558",
            "fax_number": "214-466-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4333 N JOSEY LN STE 103",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104620",
            "telephone_number": "972-219-0558",
            "fax_number": "972-436-9273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH TEXAS KIDNEY DISEASE ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH TEXAS KIDNEY DISEASE ASSOCIATES",
        "enumeration_date": "2016-05-10",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SIRENA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "214-466-7230"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146883702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.