NPIMap

Organization Active NPI

Kidney Specialists, PC

  • Nephrology Physician
  • Bettendorf, IA
National Provider Identifier
1598935488
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
29965 Issued in IA
Legal business name
KIDNEY SPECIALISTS, PC
Practice address
3682 Utica Ridge Rd
Bettendorf, IA 52722-1648
Phone
(563) 391-1024
Fax
(563) 386-0965
NPI assigned
Mar 6, 2008
Last updated
Aug 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Authorized official

Name
Mouhamed Walid Al Sheikha, M.D.NPI 1063418374
Title
Owner
Phone
(636) 506-8255

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 29965 IA Primary

Addresses

Primary practice location

3682 Utica Ridge Rd
Bettendorf, IA 52722-1648

Mailing address

25058 189TH St
Bettendorf, IA 52722-7343

Other identifiers 1

IdentifierTypeStateIssuer
1125682MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080327000375 IA Part B Supplier - Clinic/Group Practice 1456437771 Receives reassigned benefits from 6 practitioners
Practice locations: Bettendorf, IA; Davenport, IA
O20230322000691 IL Part B Supplier - Clinic/Group Practice 1456437771 Receives reassigned benefits from 1 practitioner
Practice locations: Moline, IL

National Provider Directory

National Provider Directory

Locations

3682 Utica Ridge Rd
Bettendorf, IA 52722
Phone (309) 757-7780

3682 Utica Ridge Rd
Ste A
Bettendorf, IA 52722
Phone (563) 391-1024

3682 Utica Ridge Rd
Unit A
Bettendorf, IA 52722
Phone (563) 370-1853

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1598935488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25058 189TH ST",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3682 UTICA RIDGE RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221648",
            "telephone_number": "563-391-1024",
            "fax_number": "563-386-0965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "AL SHEIKHA",
        "authorized_official_first_name": "MOUHAMED",
        "authorized_official_middle_name": "WALID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-506-8255",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IA",
            "license": "29965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1125682",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.