NPIMap

Organization Active NPI

Danville Urologic Clinic Inc

Doing business as Southside Urology & Nephrology

  • Nephrology Physician
  • Danville, VA
National Provider Identifier
1619927100
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
DANVILLE UROLOGIC CLINIC INC
Doing business as
Southside Urology & Nephrology
Practice address
1040 Main St
Danville, VA 24541-1816
Phone
(434) 792-1433
Fax
(434) 797-2807
NPI assigned
May 12, 2006
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Dr. Joseph M Carbone, MDNPI 1245282458
Title
President
Phone
(434) 792-1433

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X VA Primary
Urology Physician 208800000X VA

Addresses

Primary practice location

1040 Main St
Danville, VA 24541-1816

Mailing address

1040 Main St
P.O. Box 1360
Danville, VA 24541-1816
Phone (434) 792-1433

Other identifiers 3

IdentifierTypeStateIssuer
171773OtherVAANTHEM GROUP NUMBER
89016RWMedicaidNC
DC7953OtherVARAILROAD MEDICARE

Other names 1

  • Southside Urology & Nephrology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050119000909 VA Part B Supplier - Clinic/Group Practice 8022067743 Receives reassigned benefits from 18 practitioners
Practice locations: Danville, VA; Martinsville, VA; South Boston, VA
O20050413001064 NC Part B Supplier - Clinic/Group Practice 8022067743 Receives reassigned benefits from 8 practitioners
Practice locations: Winston Salem, NC; Yanceyville, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0665506Danville Urologic Clinic Dba Danville Urology1040 Main St, Danville, VA 24541Provider-performed microscopyOct 31, 2027

National Provider Directory

National Provider Directory

Locations

2045 Hamilton Blvd
South Boston, VA 24592
Phone (434) 572-6565

797 Woodland Dr
#102
Stuart, VA 24171
Phone (276) 638-7731

797 Woodland Dr
Ste 102
Stuart, VA 24171
Phone (276) 694-0124

Interoperability endpoints

  • Direct secure messaging: alexaelkadi@sun.medalliesdirect.net
  • Direct secure messaging: aprilcassady@sun.medalliesdirect.net
  • Direct secure messaging: carrierogers@sun.medalliesdirect.net
  • Direct secure messaging: cynthiawilborne@sun.medalliesdirect.net
  • Direct secure messaging: edwardwright@sun.medalliesdirect.net
  • Direct secure messaging: josephcarbone@sun.medalliesdirect.net

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1619927100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "address_2": "P.O. BOX 1360",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411816",
            "telephone_number": "434-792-1433",
            "fax_number": "434-797-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411816",
            "telephone_number": "434-792-1433",
            "fax_number": "434-797-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANVILLE UROLOGIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CARBONE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-792-1433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP NUMBER",
            "identifier": "171773",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016RW",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC7953",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Urology & Nephrology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southside Urology & Nephrology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.