NPIMap

Organization Active NPI

Nephrology Medical Associates of Georgia, LLC

  • Nephrology Physician
  • Birmingham, AL
National Provider Identifier
1407192172
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC
Practice address
3570 Grandview Pkwy Ste 2
Birmingham, AL 35243-2064
Phone
(205) 354-2100
Fax
(866) 343-6766
NPI assigned
Dec 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Jennie Peterson
Title
VP of Operations
Phone
(205) 983-1120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

3570 Grandview Pkwy Ste 2
Birmingham, AL 35243-2064

Mailing address

1840 E. Ray Road
Chandler, AZ 85225
Phone (205) 354-2100

Other names 1

  • Southern Kidney Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130124000258 AL Part B Supplier - Clinic/Group Practice 5991600629 Receives reassigned benefits from 3 practitioners
5 other NPIs on this enrollment
Practice locations: Birmingham, AL; Fultondale, AL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Davita Kidney Specialists of Alabama5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3570 Grandview Pkwy
Ste 102
Birmingham, AL 35243
Phone (205) 977-2274

833 Saint Vincents Dr
Ste 201
Birmingham, AL 35205
Phone (205) 250-8910

3570 Grandview Pkwy
Ste 101
Birmingham, AL 35243
Phone (205) 354-2100

3570 Grandview Pkwy
Ste 2
Birmingham, AL 35243
Phone (205) 354-2100

209 W Spring St
Ste 103
Sylacauga, AL 35150
Phone (205) 354-2100

Practitioners & affiliated clinicians

Practitioners 4

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": "1356566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1407192172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 E. RAY ROAD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85225",
            "telephone_number": "205-354-2100",
            "fax_number": "866-343-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 GRANDVIEW PKWY STE 2",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352432064",
            "telephone_number": "205-354-2100",
            "fax_number": "866-343-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPHROLOGY MEDICAL ASSOCIATES OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "205-983-1120"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.