NPIMap

Organization Active NPI

Athens Kidney Center, P.C.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hartwell, GA
National Provider Identifier
1710296199
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
ATHENS KIDNEY CENTER, P.C.
Practice address
98 Arthur Street
Hartwell, GA 30643-1804
Phone
(706) 543-6397
NPI assigned
Oct 1, 2010
Organization subpart
Yes
Parent organization
ATHENS KIDNEY CENTER, P.C..As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Dr. Azubueze A Adogu, MD
Title
President / Ceo
Phone
(706) 543-6397

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

98 Arthur Street
Hartwell, GA 30643-1804

Mailing address

98 Arthur Street
Hartwell, GA 30643-1804
Phone (706) 543-6397

Other identifiers 1

IdentifierTypeStateIssuer
003136746AMedicaidGA

Other names 1

  • LAKE HARTWELL KIDNEY CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110310001123 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9739127036 Practice locations: Hartwell, GA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Lake Hartwell Kidney CenterCCN 112843
Ownership
Profit
Certified
Sep 29, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
13

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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
11D2027958Lake Hartwell Kidney Center98 Arthur Street, Hartwell, GA 30643Certificate of waiverAug 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Oconee Medical Group5 organizations share this tax ID, including this one
Part of
Oconee Medical Group

Other organizations with this tax ID 4

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

Locations

98 Arthur St
Hartwell, GA 30643
Phone (706) 543-6397

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1710296199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 ARTHUR STREET",
            "city": "HARTWELL",
            "state": "GA",
            "postal_code": "306431804",
            "telephone_number": "706-543-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 ARTHUR STREET",
            "city": "HARTWELL",
            "state": "GA",
            "postal_code": "306431804",
            "telephone_number": "706-543-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS KIDNEY CENTER, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHENS KIDNEY CENTER, P.C..",
        "enumeration_date": "2010-10-01",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "ADOGU",
        "authorized_official_first_name": "AZUBUEZE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "706-543-6397",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003136746A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE HARTWELL KIDNEY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hartwell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.