NPIMap

Organization Active NPI

Kidney Replacement Therapies, SC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kenosha, WI
National Provider Identifier
1720283302
Registry record updated Dec 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
40695-20 Issued in WI
Legal business name
KIDNEY REPLACEMENT THERAPIES, SC
Practice address
6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2928
Phone
(262) 564-8636
Fax
(262) 564-8637
NPI assigned
Jun 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2014

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

Authorized official

Name
Ganesh N Pulla, MDNPI 1679620918
Title
Doctor
Phone
(262) 564-8636

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
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 40695-20 WI Primary

Addresses

Primary practice location

6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2928

Mailing address

6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2928
Phone (262) 564-8636

Other identifiers 1

IdentifierTypeStateIssuer
21279800MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1720283302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "SUITE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636",
            "fax_number": "262-564-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "SUITE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636",
            "fax_number": "262-564-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY REPLACEMENT THERAPIES, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "PULLA",
        "authorized_official_first_name": "GANESH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "262-564-8636",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WI",
            "license": "40695-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21279800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.