NPIMap

Organization Active NPI

Mohawk Valley Nephrology Associates, LLP

Doing business as Mohawk Valley Nephrology Associates

  • Nephrology Physician
  • Utica, NY
National Provider Identifier
1548287329
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP
Doing business as
Mohawk Valley Nephrology Associates
Practice address
125 Business Park Dr Ste 150
Utica, NY 13502-6322
Phone
(315) 735-3541
Fax
(315) 724-3255
NPI assigned
Jul 16, 2006
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Mrs. Lorraine A Lane
Title
Billing Manager
Phone
(315) 724-3880

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

125 Business Park Dr Ste 150
Utica, NY 13502-6322

Mailing address

125 Business Park Dr Ste 150
Utica, NY 13502-6322
Phone (315) 735-3541

Other identifiers 1

IdentifierTypeStateIssuer
DC5232OtherNYRAILROAD MEDICARE

Other names 1

  • Mohawk Valley Nephrology Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040902001124 NY Part B Supplier - Clinic/Group Practice 8921074717 Receives reassigned benefits from 7 practitioners
Practice locations: Utica, NY

National Provider Directory

National Provider Directory

Locations

555 French Rd
Ste 103
New Hartford, NY 13413
Phone (315) 624-7500

125 Business Park Dr
Ste 150
Utica, NY 13502
Phone (315) 235-2540

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": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1548287329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BUSINESS PARK DR STE 150",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026322",
            "telephone_number": "315-735-3541",
            "fax_number": "315-724-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BUSINESS PARK DR STE 150",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026322",
            "telephone_number": "315-735-3541",
            "fax_number": "315-724-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAWK VALLEY NEPHROLOGY ASSOCIATES, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "315-724-3880",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC5232",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohawk Valley Nephrology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Utica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; 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.