St Petersburg Kidney Care LLC

Primary specialty

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

Legal business name

ST PETERSBURG KIDNEY CARE LLC

Practice address

800 3Rd Ave S
Webb Plaza
St Petersburg, FL 33701-4010

Phone

(727) 821-3201

Fax

(727) 821-3140

NPI assigned

Mar 26, 2012

Organization subpart

No

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

Authorized official

Name

Sara Anne Brady

Title

Chief Nursing Officer

Phone

(208) 371-7878

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ST. PETERSBURG KIDNEY CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

St Petersburg Kidney CareCCN 682522

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jul 16, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Chain

American Renal Associates

Dialysis stations

17

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

CLIA laboratory certificates

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Affiliated clinicians 2

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

• Nehal Subhash Dassani, MD

  • Nephrology Physician
  • St Petersburg, FL
  • NPI 1164584660

  Dialysis facility

  Care Compare affiliation Name & address match
• Edward M Fabelo, MD

  • Nephrology Physician
  • St. Petersburg, FL
  • NPI 1326263955

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673654400000",
    "number": "1326314295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 3RD AVE S",
            "address_2": "WEBB PLAZA",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014010",
            "telephone_number": "727-821-3201",
            "fax_number": "727-821-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 3RD AVE S",
            "address_2": "WEBB PLAZA",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014010",
            "telephone_number": "727-821-3201",
            "fax_number": "727-821-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETERSBURG KIDNEY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-26",
        "last_updated": "2023-01-14",
        "certification_date": "2023-01-14",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "208-371-7878"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006736000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. PETERSBURG KIDNEY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2023; 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.