NPIMap

Organization Active NPI

Daytona Beach Nephrology LLC

  • Nephrology Physician
  • Port Orange, FL
National Provider Identifier
1376193029
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
DAYTONA BEACH NEPHROLOGY LLC
Practice address
1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923
Phone
(386) 304-8302
Fax
(386) 304-8204
NPI assigned
Sep 16, 2019
Last updated
Aug 31, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Rajdeep Singh Gadh, MDNPI 1811929144
Title
Owner
Phone
(386) 304-8302

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 Physician 207RN0300X NU Primary

Addresses

Primary practice location

1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923

Mailing address

1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923
Phone (386) 304-8302

Other practice location 1

335 Clyde Morris Blvd Ste 260
Ormond Beach, FL 32174-3196
Phone (386) 304-8302

Other practice location 2

125 Florida Memorial Pkwy Ste 2300
New Smyrna Beach, FL 32168-9309
Phone (386) 304-8302

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191114000265 FL Part B Supplier - Clinic/Group Practice 2365874211 Receives reassigned benefits from 2 practitioners
Practice locations: Daytona Beach, FL

National Provider Directory

National Provider Directory

Locations

1728 Dunlawton Ave
Ste 4
Port Orange, FL 32127
Phone (386) 304-8302

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20431/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1376193029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 DUNLAWTON AVE STE 4",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272923",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 DUNLAWTON AVE STE 4",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272923",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 Clyde Morris Blvd Ste 260",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321743196",
            "country_code": "US",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Florida Memorial Pkwy Ste 2300",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321689309",
            "country_code": "US",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DAYTONA BEACH NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-16",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "GADH",
        "authorized_official_first_name": "RAJDEEP",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-304-8302",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.