Carolina Nephrology PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

0094-00540 Issued in NC

Legal business name

CAROLINA NEPHROLOGY PA

Practice address

1704A Wayne Memorial Drive
Goldsboro, NC 27534

Phone

(919) 580-1026

Fax

(919) 580-1027

NPI assigned

Feb 7, 2007

Last updated

Feb 6, 2008By 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

Robert David Kemp, MDNPI 1932293131

Title

President Owner

Phone

(919) 580-1026

Specialties & licenses 2

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

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.

• Robert David Kemp, MD

  • Nephrology Physician
  • Goldsboro, NC
  • NPI 1932293131
  Medicare reassignment Care Compare group NPD Authorized official
• Pamela Dawn Branson, FNP-C

  • Family Nurse Practitioner
  • Goldsboro, NC
  • NPI 1679225130
  Medicare reassignment Care Compare group NPD
• Ajay Iyengar Shreenath, MD

  • Nephrology Physician
  • Goldsboro, NC
  • NPI 1790879997
  Medicare reassignment Care Compare group NPD
• Roopa Shah, MD

  • Nephrology Physician
  • Monroe, NC
  • NPI 1619396108
  Medicare reassignment NPD

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1659411924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704A WAYNE MEMORIAL DRIVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-1026",
            "fax_number": "919-580-1027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704A WAYNE MEMORIAL DRIVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-1026",
            "fax_number": "919-580-1027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA NEPHROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "KEMP",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "919-580-1026",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "2005-00739",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "0094-00540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790294F",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1193E",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER INDIVIDUAL NPI",
            "identifier": "1225026289",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891193E",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0294F",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14OUT",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER INDIVIDUAL NPI",
            "identifier": "1790879997",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER INDIVIDUAL NPI",
            "identifier": "1932293131",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901460",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mario Carmichael
• Carolina Clinical Counseling, PLLC
• Carolina Compounding Center Inc
• Carolina Kidney and Vascular, PA
• Carolina Kidney and Vascular, PA
• Carolina Outreach, LLC
• Carolina Residential Services, Inc
• Carolina Residential Services, Inc.
• George Carr, LCSW, LCAS, CCS
• Raevon Shawnte Carr, LCSWA

• Nephrology Physician in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Nephrology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.