NPIMap

Individual provider Active NPI

David Edwin Allen, M.D.

  • Nephrology Physician
  • Augusta, GA
National Provider Identifier
1194705434
Registry record updated May 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
057919 Issued in GA
Practice address
818 Saint Sebastian Way
Suite 300
Augusta, GA 30901-2651
Phone
(706) 722-0186
Fax
(706) 722-0290
NPI assigned
Jan 20, 2006
Last updated
May 17, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 16000 MS
Nephrology Physician 207RN0300X 057919 GA Primary
Nephrology Physician 207RN0300X 28888 SC

Addresses

Primary practice location

818 Saint Sebastian Way
Suite 300
Augusta, GA 30901-2651

Mailing address

818 Saint Sebastian Way
Ste 300
Augusta, GA 30901-2653
Phone (706) 364-4102

Other identifiers 1

IdentifierTypeStateIssuer
352045041AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 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
I20060906000346 GA Practitioner - Nephrology 9830193853 Reassigns benefits to 1 organization
I20090415000049 SC Practitioner - Nephrology 9830193853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Augusta Nephrology and Internal Medicine Associates, PCGroup PAC ID 0749271740, 5 clinicians

Practice addresses (Care Compare)

10263 Atomic Rd
North Augusta, SC 29841-4484
Phone (706) 722-0186

818 Saint Sebastian Way
Augusta, GA 30901-2652
Phone (706) 722-0186

818 Saint Sebastian Way
Suite 300
Augusta, GA 30901-2653

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16000MSMDNephrology Physician
28888SCMDAcute Care Nurse Practitioner

Organizations & group practices 1

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 11

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494979200000",
    "number": "1194705434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 SAINT SEBASTIAN WAY",
            "address_2": "STE 300",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012653",
            "telephone_number": "706-364-4102",
            "fax_number": "706-722-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 SAINT SEBASTIAN WAY",
            "address_2": "SUITE 300",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012651",
            "telephone_number": "706-722-0186",
            "fax_number": "706-722-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "DAVID",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2017-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MS",
            "license": "16000",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "057919",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "28888",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "352045041A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.