Nacogdoches Nephrology, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

J7203 Issued in TX

Legal business name

NACOGDOCHES NEPHROLOGY, PA

Practice address

626 Russell Blvd
Suite B
Nacogdoches, TX 75965-1246

Phone

(936) 552-7216

Fax

(936) 552-7274

NPI assigned

Apr 15, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Dolamu O. B. Sokunbi, M.D.NPI 1942276001

Title

Nephrologist

Phone

(936) 552-7216

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CHGBAA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dolamu Olumide Bamidele Sokunbi, M.D.

  • Nephrology Physician
  • Nacogdoches, TX
  • NPI 1942276001
  Medicare reassignment NPD Authorized official
• Carriston Hendricks, FNP-C

  • Family Nurse Practitioner
  • Center, TX
  • NPI 1750820296
  Medicare reassignment NPD

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

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239753600000",
    "number": "1710120167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 RUSSELL BLVD",
            "address_2": "SUITE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651246",
            "telephone_number": "936-552-7216",
            "fax_number": "936-552-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 RUSSELL BLVD",
            "address_2": "SUITE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651246",
            "telephone_number": "936-552-7216",
            "fax_number": "936-552-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NACOGDOCHES NEPHROLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-15",
        "last_updated": "2009-04-15",
        "status": "A",
        "authorized_official_last_name": "SOKUNBI",
        "authorized_official_first_name": "DOLAMU",
        "authorized_official_middle_name": "O. B.",
        "authorized_official_title_or_position": "NEPHROLOGIST",
        "authorized_official_telephone_number": "936-552-7216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J7203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113679803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; 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.