NPIMap

Organization Active NPI

Renal Associates of Albany, LLC

  • Nephrology Physician
  • Albany, GA
National Provider Identifier
1215419411
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
RENAL ASSOCIATES OF ALBANY, LLC
Practice address
110 Logan CT
Albany, GA 31707-3366
Phone
(706) 322-1486
Fax
(706) 324-3419
NPI assigned
Sep 4, 2018
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Mrs. Beverly Reynolds
Title
Office Manager
Phone
(706) 322-1486

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

110 Logan CT
Albany, GA 31707-3366

Mailing address

6228 Bradley Park Dr Ste a
Columbus, GA 31904-3605
Phone (706) 322-1486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190318001999 GA Part B Supplier - Clinic/Group Practice 0840530424 Receives reassigned benefits from 12 practitioners
Practice locations: Albany, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2163419Renal Associates of Albany, LLC110 Logan Court, Albany, GA 31707Certificate of waiverMar 13, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1215419411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6228 BRADLEY PARK DR STE A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043605",
            "telephone_number": "706-322-1486",
            "fax_number": "706-324-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LOGAN CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073366",
            "telephone_number": "706-322-1486",
            "fax_number": "706-324-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL ASSOCIATES OF ALBANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-04",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-322-1486",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.