Eastside Nephrology PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

EASTSIDE NEPHROLOGY PA

Doing business as

Eastside Nephrology

Practice address

15119 Wallisville Rd Ste 700
Houston, TX 77049-4631

Phone

(832) 631-9363

Fax

(832) 631-9463

NPI assigned

Oct 18, 2022

Last updated

Dec 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Salman Rasheed Mallick, MDNPI 1578892113

Title

Owner

Phone

(218) 409-9098

Specialties & licenses 1

Addresses

Other names 1

• EASTSIDE NEPHROLOGY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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.

• Salman Rasheed Mallick, M.D

  • Internal Medicine Physician
  • Minneapolis, MN
  • NPI 1578892113

  TX

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1558087726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16374 SOHM CT",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553473823",
            "telephone_number": "832-631-9363",
            "fax_number": "832-631-9463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15119 WALLISVILLE RD STE 700",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770494631",
            "telephone_number": "832-631-9363",
            "fax_number": "832-631-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE NEPHROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "MALLICK",
        "authorized_official_first_name": "SALMAN",
        "authorized_official_middle_name": "RASHEED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-409-9098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTSIDE NEPHROLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EASTSIDE NEPHROLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Easy Does It, Inc
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• Nephrology Physician in Houston, TX
• Providers in Houston, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; 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.