NPIMap

Organization Active NPI

Kidney Specialists, P.C.

  • Specialist
  • Memphis, TN
National Provider Identifier
1477680205
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD0000026012 Issued in TN
Legal business name
KIDNEY SPECIALISTS, P.C.
Practice address
1325 Eastmoreland Ave
Suite 335
Memphis, TN 38104-3519
Phone
(901) 726-1199
Fax
(901) 729-0794
NPI assigned
Feb 28, 2007
Last updated
Feb 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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

Authorized official

Name
Nawar E Mansour, M.D.NPI 1720077589
Title
Physician
Phone
(901) 729-1199

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD0000026012 TN Primary

Addresses

Primary practice location

1325 Eastmoreland Ave
Suite 335
Memphis, TN 38104-3519

Mailing address

1325 Eastmoreland Ave
Suite 335
Memphis, TN 38104-3519
Phone (901) 726-1199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000038 TN Part B Supplier - Clinic/Group Practice 6002808102 Receives reassigned benefits from 3 practitioners
Practice locations: Memphis, TN

National Provider Directory

National Provider Directory

Locations

1325 Eastmoreland Ave
Ste 335
Memphis, TN 38104
Phone (901) 726-0843

176 S Bellevue Blvd
Ste 502
Memphis, TN 38104
Phone (901) 726-1199

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1477680205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE",
            "address_2": "SUITE 335",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043519",
            "telephone_number": "901-726-1199",
            "fax_number": "901-729-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE",
            "address_2": "SUITE 335",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043519",
            "telephone_number": "901-726-1199",
            "fax_number": "901-729-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY SPECIALISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "NAWAR",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "901-729-1199",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD0000026012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; 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.