NPIMap

Organization Active NPI

Pensacola Nephrology, PA

  • Nephrology Physician
  • Niceville, FL
National Provider Identifier
1477501153
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PENSACOLA NEPHROLOGY, PA
Practice address
4304 Lancaster Dr
Niceville, FL 32578-4563
Phone
(850) 862-2385
Fax
(850) 862-0482
NPI assigned
May 4, 2006
Organization subpart
Yes
Parent organization
PENSACOLA NEPHROLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Justin Dansby
Title
Cfo
Phone
(850) 444-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

4304 Lancaster Dr
Niceville, FL 32578-4563

Mailing address

PO Box 11037
Pensacola, FL 32524-1037
Phone (850) 444-7000

Other identifiers 9

IdentifierTypeStateIssuer
256870508MedicaidFL
256870506MedicaidFL
256870500MedicaidFL
256870503MedicaidFL
256870501MedicaidFL
256870505MedicaidFL
256870502MedicaidFL
256870507MedicaidFL
256870504MedicaidFL

Other names 1

  • Renalus Center for Kidney Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pensacola Nephrology PA15 organizations share this tax ID, including this one
Part of
Pensacola Nephrology PA

Other organizations with this tax ID 14

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

View all 14

Locations

320 Redstone Ave W
Crestview, FL 32536
Phone (850) 683-5700

129 E Redstone Ave
Ste B
Crestview, FL 32539

315 Green Acres Rd
Fort Walton Beach, FL 32547
Phone (850) 314-0035

319 Green Acres Rd
#103
Fort Walton Beach, FL 32547

925 Mar Walt Dr
Fort Walton Beach, FL 32547
Phone (850) 864-4005

5976 Berryhill Rd
Milton, FL 32570
Phone (850) 626-0400

5934 Berryhill Rd
#1
Milton, FL 32570

4304 Lancaster Dr
Niceville, FL 32578
Phone (850) 729-4141

8333 N Davis Hwy
#2
Pensacola, FL 32514

1305 W Moreno St
Pensacola, FL 32501
Phone (850) 434-1176

8333 N Davis Hwy
#1
Pensacola, FL 32514

1619 Creighton Rd
Ste 101
Pensacola, FL 32504

598 N Fairfield Dr
Pensacola, FL 32506
Phone (850) 453-6066

8330 N Davis Hwy
Pensacola, FL 32514

5401 Corporate Woods Dr
Pensacola, FL 32504
Phone (850) 494-0060

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1477501153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11037",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241037",
            "telephone_number": "850-444-7000",
            "fax_number": "850-444-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4304 LANCASTER DR",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325784563",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA NEPHROLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENSACOLA NEPHROLOGY, PA",
        "enumeration_date": "2006-05-04",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "DANSBY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-444-4700"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870508",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870506",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870503",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870501",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870505",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870502",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870507",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870504",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renalus Center for Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.