NPIMap

Individual provider Active NPI

Kianoosh Kaveh, DO

  • Nephrology Physician
  • Port Charlotte, FL
National Provider Identifier
1174524219
Registry record updated Apr 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
OS8229 Issued in FL
Practice address
3221 Tamiami TRL
Port Charlotte, FL 33952-8002
Phone
(941) 505-8720
Fax
(941) 505-8747
NPI assigned
Aug 10, 2005
Last updated
Apr 29, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X OS8229 FL Primary

Addresses

Primary practice location

3221 Tamiami TRL
Port Charlotte, FL 33952-8002

Mailing address

3221 Tamiami TRL
Port Charlotte, FL 33952-8002
Phone (941) 505-8720

Other identifiers 16

IdentifierTypeStateIssuer
001457915OtherBCBS HIGHMARK
651117748TOtherILBCBS IL
2985402OtherGAAETNA BLUE BELL
7405063OtherMAMSI INS
0232474OtherFLCIGNA
2142967000OtherPAINDEPENDENCE BC PA
47881OtherFLBCBS
N279248MedicaidFL
265580200MedicaidFL
471501OtherTUFTS
KKA150339OtherBCBS EXCELLUS NY
651256OtherFLCOMBINED INS
0000ZCY746OtherMABCBS MASS
7039169OtherFLAETNA
2142967000OtherFLAMERIHEALTH
30030181OtherFLKEYSTONE MERCY HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20040902000818 FL Practitioner - NephrologyPractitioner - Internal Medicine 0840266706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

18669 Tamiami TRL
North Port, FL 34287-7388
Phone (941) 505-8720

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.29 of 100Reported as individual
Quality
73.26
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Kidney Physicians , LLC Nephrology CurrentSince Oct 1, 2021 Accepting new patients
Florida Kidney Physicians, LLC Nephrology CurrentSince Oct 1, 2021 Accepting new patients
Major Hospital Past Accepting new patients

Locations

1861 Placida Rd
Ste 203
Englewood, FL 34223

18669 Tamiami Trl
North Port, FL 34287
Phone (941) 423-5035

18669 Tamiami Trl
Ste A
North Port, FL 34287

2852 Tamiami Trl
Ste 1
Port Charlotte, FL 33952

3221 Tamiami Trl
Pt Charlotte, FL 33952

12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708

1515 Tamiami Trl S
Ste 1
Venice, FL 34285
Phone (941) 484-4929

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kianoosh.kaveh.1@15644.direct.athenahealth.com

Organizations & group practices 4

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1174524219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528002",
            "telephone_number": "941-505-8720",
            "fax_number": "941-505-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528002",
            "telephone_number": "941-505-8720",
            "fax_number": "941-505-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVEH",
        "first_name": "KIANOOSH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "OS8229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HIGHMARK",
            "identifier": "001457915",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL",
            "identifier": "651117748T",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BLUE BELL",
            "identifier": "2985402",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI INS",
            "identifier": "7405063",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0232474",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BC PA",
            "identifier": "2142967000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47881",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N279248",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265580200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "471501",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EXCELLUS NY",
            "identifier": "KKA150339",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMBINED INS",
            "identifier": "651256",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MASS",
            "identifier": "0000ZCY746",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7039169",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2142967000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTH",
            "identifier": "30030181",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.