NPIMap

Organization Active NPI

Kidney and Hypertension Center of Wabash Valley, LLC

  • Nephrology Physician
  • Terre Haute, IN
National Provider Identifier
1396182788
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01067346A Issued in IN
Legal business name
KIDNEY AND HYPERTENSION CENTER OF WABASH VALLEY, LLC
Practice address
1801 N 6TH St
Suite # 200
Terre Haute, IN 47804-4086
Phone
(812) 238-4708
NPI assigned
May 27, 2013
Last updated
Apr 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Authorized official

Name
Kumar Gaurav, MD
Title
Vice President
Phone
(812) 244-9104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 01067346A IN Primary

Addresses

Primary practice location

1801 N 6TH St
Suite # 200
Terre Haute, IN 47804-4086

Mailing address

1801 N 6TH St
Suite # 200
Terre Haute, IN 47804-4086
Phone (812) 238-4708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131113002187 IN Part B Supplier - Clinic/Group Practice 5799911145 Receives reassigned benefits from 11 practitioners
Practice locations: Brazil, IN; Terre Haute, IN; Linton, IN; Sullivan, IN; Greencastle, IN; Clinton, IN
O20220308000444 IL Part B Supplier - Clinic/Group Practice 5799911145 Receives reassigned benefits from 3 practitioners
Practice locations: Paris, IL; Robinson, IL; Martinsville, IL; Marshall, IL

National Provider Directory

National Provider Directory

Locations

1101 N Allen St
Ste B
Robinson, IL 62454
Phone (917) 445-5531

476 Buckeye St
Terre Haute, IN 47804
Phone (812) 232-2683

504 6th Ave
Terre Haute, IN 47807
Phone (812) 231-8560

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1369612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1396182788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 N 6TH ST",
            "address_2": "SUITE # 200",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478044086",
            "telephone_number": "812-238-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 N 6TH ST",
            "address_2": "SUITE # 200",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478044086",
            "telephone_number": "812-238-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY AND HYPERTENSION CENTER OF WABASH VALLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-27",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "GAURAV",
        "authorized_official_first_name": "KUMAR",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "812-244-9104",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01067346A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; 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.