NPIMap

Organization Active NPI

Northlake Nephrology Inc

Doing business as Northlake Nephrology Institute

  • Nephrology Physician
  • Covington, LA
National Provider Identifier
1366448458
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHLAKE NEPHROLOGY INC
Doing business as
Northlake Nephrology Institute
Practice address
1970 N Hwy 190
Covington, LA 70433
Phone
(985) 400-5988
Fax
(985) 256-5687
NPI assigned
Jun 22, 2005
Last updated
Sep 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Authorized official

Name
John C Simon, MDNPI 1760489892
Title
MD / Owner
Phone
(985) 867-8585

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: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1970 N Hwy 190
Covington, LA 70433

Mailing address

PO Box 3370
Covington, LA 70434-3370
Phone (985) 867-8585

Other names 1

  • Northlake Nephrology Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000752 LA Part B Supplier - Clinic/Group Practice 9931000213 Receives reassigned benefits from 24 practitioners
Practice locations: Covington, LA; Slidell, LA

National Provider Directory

National Provider Directory

Locations

190 Greenbrier Blvd
#4
Covington, LA 70433

664 Robert Blvd
Slidell, LA 70458
Phone (985) 400-5988

Interoperability endpoints

  • Direct secure messaging: danieltveit@nni.allscriptsdirect.net
  • Direct secure messaging: donnabranton@nni.allscriptsdirect.net
  • Direct secure messaging: eringill@nni.allscriptsdirect.net
  • Direct secure messaging: gabriellerutherford@nni.allscriptsdirect.net
  • Direct secure messaging: georgekeshelava@nni.allscriptsdirect.net
  • Direct secure messaging: georgikovachev@nni.allscriptsdirect.net
  • Direct secure messaging: johnsimon@nni.allscriptsdirect.net
  • Direct secure messaging: mollybroom@nni.allscriptsdirect.net
  • Direct secure messaging: rachelegibson@nni.allscriptsdirect.net
  • Direct secure messaging: sandraalmerico@nni.allscriptsdirect.net
  • Direct secure messaging: sumithaganji@nni.allscriptsdirect.net
  • Direct secure messaging: williamgabbard@nni.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1366448458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3370",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704343370",
            "telephone_number": "985-867-8585",
            "fax_number": "985-867-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 N HWY 190",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "70433",
            "telephone_number": "985-400-5988",
            "fax_number": "985-256-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE NEPHROLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MD / OWNER",
        "authorized_official_telephone_number": "985-867-8585",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northlake Nephrology Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northlake Nephrology Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.