NPIMap

Organization Active NPI

Colonial Kidneycare Specialists, PC

  • Nephrology Physician
  • Colonial Heights, VA
National Provider Identifier
1528451671
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101236668 Issued in VA
Legal business name
COLONIAL KIDNEYCARE SPECIALISTS, PC
Practice address
3601 Boulevard
Suite C
Colonial Heights, VA 23834-1338
Phone
(804) 504-0068
Fax
(804) 504-0080
NPI assigned
Mar 13, 2015
Last updated
Mar 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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

Authorized official

Name
Satish K Bankuru, M.D.NPI 1750331732
Title
President
Phone
(804) 504-0068

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
Nephrology Physician 207RN0300X 0101236668 VA Primary

Addresses

Primary practice location

3601 Boulevard
Suite C
Colonial Heights, VA 23834-1338

Mailing address

3601 Boulevard
Suite C
Colonial Heights, VA 23834-1338
Phone (804) 504-0068

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150818004783 VA Part B Supplier - Clinic/Group Practice 7315252442 Receives reassigned benefits from 8 practitioners
Practice locations: Colonial Heights, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426204800000",
    "number": "1528451671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 BOULEVARD",
            "address_2": "SUITE C",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341338",
            "telephone_number": "804-504-0068",
            "fax_number": "804-504-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 BOULEVARD",
            "address_2": "SUITE C",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341338",
            "telephone_number": "804-504-0068",
            "fax_number": "804-504-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL KIDNEYCARE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-13",
        "last_updated": "2015-03-13",
        "status": "A",
        "authorized_official_last_name": "BANKURU",
        "authorized_official_first_name": "SATISH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-504-0068",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101236668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colonial Heights, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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.