NPIMap

Organization Active NPI

Victoria Kidney & Dialysis Associates

  • Nephrology Physician
  • Victoria, TX
National Provider Identifier
1770545873
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
VICTORIA KIDNEY & DIALYSIS ASSOCIATES
Practice address
605 E San Antonio
Suite 430E
Victoria, TX 77901
Phone
(361) 576-0011
Fax
(361) 576-4084
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Authorized official

Name
Susan Mahan
Title
Medical Manager
Phone
(361) 576-0011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

605 E San Antonio
Suite 430E
Victoria, TX 77901

Mailing address

605 E San Antonio
Suite 430E
Victoria, TX 77901
Phone (361) 576-0011

Other identifiers 2

IdentifierTypeStateIssuer
080560802MedicaidTX
080560801MedicaidTX

Other names 1

  • Lloyd Lane Gober, MD, P.A. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040501000138 TX Part B Supplier - Clinic/Group Practice 8820086788 Receives reassigned benefits from 5 practitioners
Practice locations: Victoria, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1770545873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E SAN ANTONIO",
            "address_2": "SUITE 430E",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "77901",
            "telephone_number": "361-576-0011",
            "fax_number": "361-576-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E SAN ANTONIO",
            "address_2": "SUITE 430E",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "77901",
            "telephone_number": "361-576-0011",
            "fax_number": "361-576-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIA KIDNEY & DIALYSIS ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MEDICAL MANAGER",
        "authorized_official_telephone_number": "361-576-0011"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080560802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080560801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lloyd Lane Gober, MD, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.