Four Corners Nephrology Associates PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

FOUR CORNERS NEPHROLOGY ASSOCIATES PC

Practice address

1902 E 2ND Ave
Durango, CO 81301-5021

Phone

(505) 326-6521

Fax

(505) 325-6699

NPI assigned

Jul 22, 2008

Last updated

Mar 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Billie Stolworthy

Title

Office Manager

Phone

(505) 326-6521

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, CO2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

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

• Four Corners Nephrology Associates PC

  • Nephrology Physician
  • Farmington, NM
  • NPI 1144327172

  6204721731

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Four Corners Nephrology Associates PC

  • Nephrology Physician
  • Farmington, NM
  • NPI 1144327172

  O20040713001291

  Same enrollment

Locations

Practitioners 7

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.

• Mark Bevan, M.D.

  • Nephrology Physician
  • Farmington, NM
  • NPI 1720185788

  CO

  Medicare reassignment NPD
• Daniel Taiwo Adeneye, MD

  • Nephrology Physician
  • Farmington, NM
  • NPI 1770929929

  CO

  Medicare reassignment
• Franklin Lam, M.D.

  • Nephrology Physician
  • Farmington, NM
  • NPI 1194166280

  CO

  Medicare reassignment
• Mark C Saddler, MD

  • Nephrology Physician
  • Durango, CO
  • NPI 1821062282
  NPD (past)
• Neil Collinge, M.D.

  • Nephrology Physician
  • Farmington, NM
  • NPI 1912004904
  NPD (past)
• Mahendra Mangray, MD

  • Nephrology Physician
  • Portland, ME
  • NPI 1801074919
  NPD (past)
• Helbert Rondon-Berrios

  • Nephrology Physician
  • Pittsburgh, PA
  • NPI 1790982791
  NPD (past)

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1417112178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 S LAKE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015620",
            "telephone_number": "505-326-6521",
            "fax_number": "505-325-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 E 2ND AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015021",
            "telephone_number": "505-326-6521",
            "fax_number": "505-325-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS NEPHROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "STOLWORTHY",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-326-6521"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Four Corners Heart Clinic
• Four Corners Ketamine Center Inc
• Four Corners Laser and Aesthetics
• Four Corners Mental Health, LLC
• Four Corners Naturopathic
• Four Corners OB/GYN
• Four Corners Occupational Medicine Inc
• Four Corners Oral and Maxilliofacial Surgery
• Four Corners Pharmacy, LLC (Four Corners Pharmacy)
• Four Corners Psychiatry LLC

• Nephrology Physician in Durango, CO
• Providers in Durango, CO by specialty
• Nephrology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.