NPIMap

Organization Active NPI

Kidney Disease Consultants

  • Nephrology Physician
  • Florence, KY
National Provider Identifier
1669676383
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY DISEASE CONSULTANTS
Practice address
47 Cavalier Blvd
Suite 120
Florence, KY 41042-3969
Phone
(859) 534-0861
Fax
(859) 534-0865
NPI assigned
Jun 14, 2007
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Deepak Mittal, M.D.NPI 1447296538
Title
Physician
Phone
(859) 534-0861

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 NU Primary

Addresses

Primary practice location

47 Cavalier Blvd
Suite 120
Florence, KY 41042-3969

Mailing address

47 Cavalier Blvd
Suite 120
Florence, KY 41042-3969
Phone (859) 534-0861

Other identifiers 2

IdentifierTypeStateIssuer
2843249MedicaidOH
7100040200MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, OH, IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070910000747 KY Part B Supplier - Clinic/Group Practice 4688767437 Receives reassigned benefits from 10 practitioners
Practice locations: Florence, KY; Owenton, KY
O20080822000212 OH Part B Supplier - Clinic/Group Practice 4688767437 Receives reassigned benefits from 5 practitioners
Practice locations: Hillsboro, OH; Norwood, OH
O20180607000094 IN Part B Supplier - Clinic/Group Practice 4688767437 Receives reassigned benefits from 2 practitioners
Practice locations: Greendale, IN

National Provider Directory

National Provider Directory
Tax ID family
Kidney Disease Consultants2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

47 Cavalier Blvd
Ste 120
Florence, KY 41042
Phone (859) 283-0544

635 S 3rd St
Louisville, KY 40202
Phone (502) 561-1314

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1669676383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 CAVALIER BLVD",
            "address_2": "SUITE 120",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410423969",
            "telephone_number": "859-534-0861",
            "fax_number": "859-534-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 CAVALIER BLVD",
            "address_2": "SUITE 120",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410423969",
            "telephone_number": "859-534-0861",
            "fax_number": "859-534-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY DISEASE CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "859-534-0861",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2843249",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100040200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.