NPIMap

Organization Active NPI

Nephrology Medical Associates of Georgia LLC

  • Nephrology Physician
  • Lakewood, CO
National Provider Identifier
1285694836
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA LLC
Practice address
1627 Cole Blvd BLDG 18
Lakewood, CO 80401-3315
Phone
(303) 626-6239
Fax
(866) 917-5396
NPI assigned
Mar 27, 2006
Last updated
Dec 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Authorized official

Name
Mr. Dennis Johnson
Title
Director
Phone
(303) 626-6239

Specialties & licenses 1

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

Addresses

Primary practice location

1627 Cole Blvd BLDG 18
Lakewood, CO 80401-3315

Mailing address

14546 Old Saint Augustine Rd Ste 301
Jacksonville, FL 32258-5472
Phone (303) 626-6239

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130124000258 AL Part B Supplier - Clinic/Group Practice 5991600629 Receives reassigned benefits from 3 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Birmingham, AL; Fultondale, AL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1285694836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD STE 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585472",
            "telephone_number": "303-626-6239",
            "fax_number": "866-917-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 COLE BLVD BLDG 18",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013315",
            "telephone_number": "303-626-6239",
            "fax_number": "866-917-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "303-626-6239",
        "authorized_official_name_prefix": "Mr."
    },
    "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 Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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.