NPIMap

Organization Active NPI

Intermed Consultants Dialysis, PLLC

  • Nephrology Physician
  • Edina, MN
National Provider Identifier
1376912857
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
INTERMED CONSULTANTS DIALYSIS, PLLC
Practice address
6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone
(952) 920-2070
Fax
(952) 920-7444
NPI assigned
Sep 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Authorized official

Name
Rajiv R Shah, M.D.NPI 1366556854
Title
President
Phone
(952) 920-2070

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: 193400000X SINGLE SPECIALTY GROUP 207RN0300X MN Primary

Addresses

Primary practice location

6363 France Ave S
Suite 400
Edina, MN 55435-2129

Mailing address

6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone (952) 920-2070

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151009002328 MN Part B Supplier - Clinic/Group Practice 7012225105 Receives reassigned benefits from 13 practitioners
Practice locations: Edina, MN

National Provider Directory

National Provider Directory

Locations

6200 Shingle Creek Pkwy
Ste 260
Minneapolis, MN 55430
Phone (763) 544-0696

5354 Edgewood Dr
Saint Paul, MN 55112

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1376912857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "952-920-2070",
            "fax_number": "952-920-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "952-920-2070",
            "fax_number": "952-920-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMED CONSULTANTS DIALYSIS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RAJIV",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-920-2070",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.