Active NPI
Northlake Nephrology Inc
- Nephrology Physician
- Covington, LA
National Provider Identifier
1366448458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- Legal business name
- NORTHLAKE NEPHROLOGY INC
- Practice address
- 1970 N Hwy 190
Covington, LA 70433 - Phone
- (985) 400-5988
- Fax
- (985) 256-5687
- NPI assigned
- Jun 22, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John C Simon, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 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 identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1442577 | Medicaid | LA |
Other names 1
- Northlake Nephrology Institute
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
190 Greenbrier Blvd
#4
Covington, LA 70433
105 Medical Center Dr
Ste 303
Slidell, LA 70461
Phone (985) 661-3591
664 Robert Blvd
Slidell, LA 70458
Phone (985) 400-5988
1150 Robert Blvd
Ste 240
Slidell, LA 70458
Phone (985) 643-7476
Interoperability endpoints
- williamgabbard@nni.allscriptsdirect.net
- sandraalmerico@nni.allscriptsdirect.net
- georgikovachev@nni.allscriptsdirect.net
- johnsimon@nni.allscriptsdirect.net
- sumithaganji@nni.allscriptsdirect.net
- rachelegibson@nni.allscriptsdirect.net
- donnabranton@nni.allscriptsdirect.net
- gabriellerutherford@nni.allscriptsdirect.net
- eringill@nni.allscriptsdirect.net
- mollybroom@nni.allscriptsdirect.net
- danieltveit@nni.allscriptsdirect.net
- georgekeshelava@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.
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1442577",
"state": "LA"
}
],
"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
- Normandy Surgical Suite LLC
- Alle Duvall Norris, FNP
- North Shore MRI LLC
- Northlake Medical Supply, Inc
- Northlake Medicine and Wellness Center, LLC
- Northlake Nephrology Physicians Group LLC
- Northlake Neurorehab Center
- Northlake Pharmacy Inc
- Northlake Pulmonary Associates Inc.
- Northlake Surgical Associates, LTD a Professional Medical Corporation
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.