NPIMap

Organization Active NPI

Renal Associates of Alabama, LLC

  • Nephrology Physician
  • Montgomery, AL
National Provider Identifier
1447742168
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
RENAL ASSOCIATES OF ALABAMA, LLC
Practice address
42 Mitylene Park Lane
Montgomery, AL 36117
Phone
(334) 603-6626
Fax
(334) 239-7808
NPI assigned
May 30, 2018
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Mr. Ferdinand Q Alcaide, MDNPI 1356337679
Title
Owner/Partner
Phone
(706) 322-1486

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

42 Mitylene Park Lane
Montgomery, AL 36117

Mailing address

6228 Bradley Park Dr Ste a
Columbus, GA 31904-3605
Phone (706) 322-1486

Other practice location 1

277 Huntress St
Wetumpka, AL 36092-3329
Phone (334) 603-6626

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181114000543 AL Part B Supplier - Clinic/Group Practice 7113271982 Receives reassigned benefits from 16 practitioners
Practice locations: Montgomery, AL; Wetumpka, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2292887Renal Associates of Alabama, LLC42 Mitylene Park Lane, Montgomery, AL 36117Certificate of waiverOct 30, 2027

National Provider Directory

National Provider Directory

Locations

42 Mitylene Park Ln
Montgomery, AL 36117
Phone (334) 603-6626

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1447742168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6228 BRADLEY PARK DR STE A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043605",
            "telephone_number": "706-322-1486",
            "fax_number": "706-324-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 MITYLENE PARK LANE",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36117",
            "telephone_number": "334-603-6626",
            "fax_number": "334-239-7808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "277 Huntress St",
            "address_purpose": "LOCATION",
            "city": "Wetumpka",
            "state": "AL",
            "postal_code": "360923329",
            "country_code": "US",
            "telephone_number": "334-603-6626",
            "fax_number": "334-239-7808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RENAL ASSOCIATES OF ALABAMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "ALCAIDE",
        "authorized_official_first_name": "FERDINAND",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "706-322-1486",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.