Usrc Covington LLC

Primary specialty

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

Legal business name

USRC COVINGTON LLC

Practice address

4179 Baker St NE
Covington, GA 30014-1405

Phone

(770) 385-4015

Fax

(770) 385-6701

NPI assigned

Jun 13, 2017

Organization subpart

Yes

Parent organization

U.S. RENAL CARE, INC.As reported in NPPES

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

Authorized official

Name

Thomas L Weinberg

Title

Chairman

Phone

(214) 736-2730

Specialties & licenses 1

Addresses

Other names 1

• U.S. Renal Care Covington Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

USRC Covington DialysisCCN 112708

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Dec 21, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

16

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

US Renal Care Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Dialysis Newco LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Viera, FL
  • NPI 1982970554

  Member Of

  NPD member

Practitioners 1

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

• Sitharam Chowdary Nandigam, MD

  • Nephrology Physician
  • Conyers, GA
  • NPI 1003096793
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Yilikal Tassew Kassa, MD

  • Nephrology Physician
  • Conyers, GA
  • NPI 1114222676

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497312000000",
    "number": "1184154148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5851 LEGACY CIR STE 900",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750245982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4179 BAKER ST NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141405",
            "telephone_number": "770-385-4015",
            "fax_number": "770-385-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USRC COVINGTON LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U.S. RENAL CARE, INC.",
        "enumeration_date": "2017-06-13",
        "last_updated": "2017-06-13",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "214-736-2730"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U.S. Renal Care Covington Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "U.S. Renal Care Covington Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Covington, GA
• Providers in Covington, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2017; 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.