NPIMap

Individual provider Active NPI

Laith Moufed Al Dahabreh, MD

  • Nephrology Physician
  • Albany, GA
National Provider Identifier
1164918967
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
91278 Issued in GA
Practice address
1200 N Jefferson St
Albany, GA 31701-2057
Phone
(216) 856-0854
NPI assigned
Jul 3, 2018
Last updated
Apr 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Nephrology Physician 207RN0300X 91278 GA Primary

Addresses

Primary practice location

1200 N Jefferson St
Albany, GA 31701-2057

Mailing address

245 Oakland Pkwy
Leesburg, GA 31763-1809
Phone (216) 856-0854

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220622001248 GA Practitioner - Nephrology 8729336383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 N Jefferson St
Albany, GA 31701-2057
Phone (229) 888-3970

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.31 of 100Reported as individual
Quality
78.62
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Ga. Nephrology Clinic, P.C. Nephrology CurrentSince Jul 1, 2022 Accepting new patients
Southwest Ga Nephrology Clinic PC CurrentSince Jul 1, 2022 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1200 N Jefferson St
Albany, GA 31701
Phone (229) 888-3970

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 9

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": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1164918967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 OAKLAND PKWY",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317631809",
            "telephone_number": "216-856-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N JEFFERSON ST",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012057",
            "telephone_number": "216-856-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL DAHABREH",
        "first_name": "LAITH",
        "middle_name": "MOUFED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-03",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "91278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

Verify at the official NPI Registry.