NPIMap

Individual provider Active NPI

Gabino Manuel Mariano Maza Rodas, M.D.

  • Nephrology Physician
  • Madison, WI
National Provider Identifier
1710484241
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
75118-20 Issued in WI
Practice address
1685 Highland Ave
Madison, WI 53705-2281
Phone
(608) 265-7593
NPI assigned
Apr 11, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125.072445 IL
Nephrology Physician 207RN0300X 75118-20 WI Primary

Addresses

Primary practice location

1685 Highland Ave
Madison, WI 53705-2281

Mailing address

749 University Row Ste 200
Madison, WI 53705-1465
Phone (708) 783-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230424002389 TN Practitioner - NephrologyPractitioner - Internal Medicine 8527316892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Care Clinic PLLCGroup PAC ID 6406244599, 7 clinicians

Practice addresses (Care Compare)

427 N Willow Ave
Suite C
Cookeville, TN 38501-2354
Phone (931) 650-0075

Hospital & facility affiliations

  • DaVita Cookeville Dialysis Dialysis facility, Cookeville, TN, CCN 442511
  • DaVita Livingston TN Dialysis Dialysis facility, Livingston, TN, CCN 442669
  • Usrc Manchester Dialysis Dialysis facility, Manchester, TN, CCN 442665
  • DaVita Foreman Drive Home Training Dialysis facility, Cookeville, TN, CCN 442758
  • FKC Crossville Home Therapies Dialysis facility, Crossville, TN, CCN 442772
  • Cookeville Regional Medical Center Hospital, Cookeville, TN, CCN 440059
  • Cumberland Medical Center Hospital, Crossville, TN, CCN 440009
  • Livingston Regional Hospital Hospital, Livingston, TN, CCN 440187
  • Saint Thomas River Park Hospital Hospital, McMinnville, TN, CCN 440151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75118-20WIMDNephrology Physician
125.072445ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Health Care LLC Nephrology CurrentSince Feb 15, 2023 Accepting new patients
Kidney Care Clinic PLLC Nephrology CurrentSince Feb 15, 2023 Accepting new patients

Locations

427 N Willow Ave
Ste C
Cookeville, TN 38501
Phone (931) 559-5959

Interoperability endpoints

  • Direct secure messaging: gabino.maza.rodas.1@24232.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1710484241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 UNIVERSITY ROW STE 200",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537051465",
            "telephone_number": "708-783-3400",
            "fax_number": "708-783-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537052281",
            "telephone_number": "608-265-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZA RODAS",
        "first_name": "GABINO",
        "middle_name": "MANUEL MARIANO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.072445",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "75118-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.