Mid-South Nephrology Consultants PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

MID-SOUTH NEPHROLOGY CONSULTANTS PLLC

Practice address

6490 Mount Moriah Road Ext Ste 200
Memphis, TN 38115-3841

Phone

(901) 565-0244

Fax

(901) 565-0616

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Dominga Hernandez

Title

Chief Executive Officer

Phone

(901) 565-0244

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MS, AR, TN3 enrollments

Enrollment records 3

Locations

Practitioners 21

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

• Shirea Davis, FNP-C

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1124642491

  AR, MS, TN

  Medicare reassignment Care Compare group NPD
• Darryl Elefan, M.D.

  • Nephrology Physician
  • Memphis, TN
  • NPI 1891927182

  AR, MS, Nephrology, TN

  Medicare reassignment Care Compare group NPD
• Darcel Higgins, FNP-C

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1871167338

  AR, MS, TN

  Medicare reassignment Care Compare group NPD
• Saundra Gail Homan, FNP

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1780107219

  AR, MS, TN

  Medicare reassignment Care Compare group NPD
• Naing Lin Htike, M.D.

  • Nephrology Physician
  • Memphis, TN
  • NPI 1891020871

  AR, MS, Nephrology, TN

  Medicare reassignment Care Compare group NPD
• Roxanna Jennings, FNP-BC

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1811704885

  TN

  Medicare reassignment Care Compare group NPD
• Patrick S Kulubya, M.D.

  • Nephrology Physician
  • Memphis, TN
  • NPI 1720057714

  AR, MS, Nephrology, TN

  Medicare reassignment Care Compare group NPD
• Abhishek Jagdish Patel, M.D.

  • Nephrology Physician
  • Memphis, TN
  • NPI 1992019129

  AR, MS, Multi-Specialty, TN

  Medicare reassignment Care Compare group NPD
• Konrad Tomaz Stepniakowski, MD

  • Specialist
  • Memphis, TN
  • NPI 1518900257

  AR, MS, TN

  Medicare reassignment Care Compare group NPD
• Pamala Terry, AGNP-C

  • Gerontology Nurse Practitioner
  • Jackson, TN
  • NPI 1043048200

  AR, MS, TN

  Medicare reassignment Care Compare group NPD
• Athip Vatanapradith, MD

  • Nephrology Physician
  • Memphis, TN
  • NPI 1992202899

  AR, MS, Single Specialty, TN

  Medicare reassignment Care Compare group NPD
• Justin Leonadus Yancey, D.O.

  • Nephrology Physician
  • Germantown, TN
  • NPI 1013390467

  AR, MS, Nephrology, TN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1346219342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6490 MOUNT MORIAH ROAD EXT STE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381153841",
            "telephone_number": "901-565-0244",
            "fax_number": "901-565-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6490 MOUNT MORIAH ROAD EXT STE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381153841",
            "telephone_number": "901-565-0244",
            "fax_number": "901-565-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH NEPHROLOGY CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2012-02-29",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "DOMINGA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "901-565-0244"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208992305",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3373435",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5B527",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152287002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4030327",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09983030",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Memphis, TN
• Nephrology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; 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.