NPIMap

Organization Active NPI

Permian Basin Kidney Center Inc

  • Nephrology Physician
  • Odessa, TX
National Provider Identifier
1285199026
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PERMIAN BASIN KIDNEY CENTER INC
Practice address
410 N Hancock Ave
Odessa, TX 79761-5140
Phone
(432) 279-0905
Fax
(432) 279-0904
NPI assigned
Feb 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Anand Reddy, MDNPI 1780892760
Title
Owner
Phone
(314) 378-7270

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

410 N Hancock Ave
Odessa, TX 79761-5140

Mailing address

410 N Hancock Ave
Odessa, TX 79761-5140
Phone (432) 279-0905

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190501001534 TX Part B Supplier - Clinic/Group Practice 6406198019 Receives reassigned benefits from 7 practitioners
Practice locations: Odessa, TX; Midland, TX

National Provider Directory

National Provider Directory

Locations

207 Tradewinds Blvd
Ste B
Midland, TX 79706
Phone (432) 687-4044

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1549411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1285199026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N HANCOCK AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615140",
            "telephone_number": "432-279-0905",
            "fax_number": "432-279-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N HANCOCK AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615140",
            "telephone_number": "432-279-0905",
            "fax_number": "432-279-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERMIAN BASIN KIDNEY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-06",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "ANAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-378-7270",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.