NPIMap

Individual provider Active NPI

Chinmay P Patel, MD

  • Nephrology Physician
  • Longview, TX
National Provider Identifier
1164713095
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
S7930 Issued in TX
Practice address
3535 N Fourth St Ste 301
Longview, TX 75605-0037
Phone
(903) 234-9992
Fax
(903) 234-8287
NPI assigned
Apr 26, 2011
Last updated
Oct 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X S7930 TX Primary
Nephrology Physician 207RN0300X 324047 LA

Addresses

Primary practice location

3535 N Fourth St Ste 301
Longview, TX 75605-0037

Mailing address

3535 N Fourth St Ste 301
Longview, TX 75605-0037
Phone (903) 234-9992

Other practice location 1

1815 E 70th St
Shreveport, LA 71105-5301
Phone (800) 276-9017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200915003078 LA Practitioner - Nephrology 3678742285 Reassigns benefits to 1 organization
I20200915003282 TX Practitioner - Nephrology 3678742285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Kidney Associates PLLCGroup PAC ID 8325382146, 6 clinicians
East Texas Kidney Specialists,PAGroup PAC ID 6901856806, 10 clinicians

Practice addresses (Care Compare)

1815 E 70TH St
Shreveport, LA 71105-5301
Phone (318) 585-5555

3535 N 4TH St
Suite 301
Longview, TX 75605-0037
Phone (903) 234-9992

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
324047LAMDNephrology Physician
S7930TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Texas Kidney Specialists,PA Nephrology CurrentSince Sep 10, 2020 Accepting new patients
Southern Kidney Associates PLLC Nephrology CurrentSince Sep 10, 2020 Accepting new patients
Pikeville Medical Center Inc Past Accepting new patients

Locations

1815 E 70th St
Shreveport, LA 71105
Phone (318) 585-5555

3535 N Fourth St
Ste 301
Longview, TX 75605
Phone (903) 234-9992

Interoperability endpoints

  • Direct secure messaging: chinmay.patel@direct.davitaphysiciansolutions.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1164713095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992",
            "fax_number": "903-234-8287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E 70th St",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055301",
            "country_code": "US",
            "telephone_number": "800-276-9017",
            "fax_number": "903-234-8287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "CHINMAY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-26",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "S7930",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "324047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.