NPIMap

Organization Active NPI

Clinic for Kidney Diseases PA

  • Nephrology Physician
  • Jacksonville, FL
National Provider Identifier
1467471672
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME24762 Issued in FL
Legal business name
CLINIC FOR KIDNEY DISEASES PA
Practice address
2585 Herschel St
Jacksonville, FL 32204-4557
Phone
(904) 388-2678
Fax
(904) 388-6776
NPI assigned
Jul 19, 2006
Last updated
Jan 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

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

Authorized official

Name
Dr. Dinesh Jayadevappa, MDNPI 1467427492
Title
President
Phone
(904) 388-2678

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X ME24762 FL Primary

Addresses

Primary practice location

2585 Herschel St
Jacksonville, FL 32204-4557

Mailing address

2585 Herschel St
Jacksonville, FL 32204-4557
Phone (904) 388-2678

Other identifiers 2

IdentifierTypeStateIssuer
255215900MedicaidFL
99457OtherFLBCBS GROUP #

National Provider Directory

National Provider Directory

Locations

3132 Saint Johns Bluff Rd S
Jacksonville, FL 32246
Phone (904) 343-0521

5730 Bowden Rd
Jacksonville, FL 32216

9535 Regency Square Blvd N
Jacksonville, FL 32225
Phone (904) 725-0526

1711 5th St S
#B
Jacksonville Beach, FL 32250
Phone (904) 247-9974

905 Beach Blvd
#B
Jacksonville Beach, FL 32250
Phone (904) 246-4831

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1467471672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2585 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044557",
            "telephone_number": "904-388-2678",
            "fax_number": "904-388-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2585 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044557",
            "telephone_number": "904-388-2678",
            "fax_number": "904-388-6776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC FOR KIDNEY DISEASES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "JAYADEVAPPA",
        "authorized_official_first_name": "DINESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-388-2678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME24762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255215900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "99457",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.