NPIMap

Individual provider Active NPI

Imtiaz Islam, M.D.

  • Nephrology Physician
  • Kearney, NE
National Provider Identifier
1336122597
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
21996 Issued in NE
Practice address
3219 Central Ave
Suite 200
Kearney, NE 68847-2949
Phone
(308) 865-2370
NPI assigned
Nov 22, 2005
Last updated
Oct 18, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 21996 NE Primary

Addresses

Primary practice location

3219 Central Ave
Suite 200
Kearney, NE 68847-2949

Mailing address

3219 Central Ave
Suite 200
Kearney, NE 68847-2949
Phone (308) 865-2370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091202000419 NE Practitioner - Nephrology 7719067032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHI Health Clinic Specialty LLCGroup PAC ID 4789098443, 317 clinicians

Practice addresses (Care Compare)

3219 Central Ave
Suite 200
Kearney, NE 68847-2958
Phone (308) 865-2370

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21996NEMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Platte Valley Medical Group, P.C. Current Accepting new patients
CHI Health Clinic Specialty, LLC Nephrology CurrentSince Jan 1, 2021 Accepting new patients
Lincoln Physician Network LLC Past Accepting new patients

Locations

1423 7th St
Aurora, NE 68818
Phone (402) 694-3171

2620 W Faidley Ave
Grand Island, NE 68803
Phone (308) 382-6856

3219 Central Ave
Ste 200
Kearney, NE 68847
Phone (308) 865-2263

816 22nd Ave
Ste 100
Kearney, NE 68845
Phone (308) 865-2263

8207 Northwoods Dr
Ste 100
Lincoln, NE 68505
Phone (402) 484-3440

Interoperability endpoints

  • Direct secure messaging: imtiaz.islam.1@16664.direct.athenahealth.com

Organizations & group practices 3

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 8

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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1336122597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3219 CENTRAL AVE",
            "address_2": "SUITE 200",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688472949",
            "telephone_number": "308-865-2370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3219 CENTRAL AVE",
            "address_2": "SUITE 200",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688472949",
            "telephone_number": "308-865-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "IMTIAZ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NE",
            "license": "21996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

Verify at the official NPI Registry.