NPIMap

Individual provider Active NPI

Ajay Iyengar Shreenath, MD

  • Nephrology Physician
  • Goldsboro, NC
National Provider Identifier
1790879997
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
200500739 Issued in NC
Practice address
1704A Wayne Memorial Drive
Goldsboro, NC 27534
Phone
(919) 580-1026
Fax
(919) 580-1027
NPI assigned
Oct 3, 2006
Last updated
Feb 6, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 200500739 NC Primary

Addresses

Primary practice location

1704A Wayne Memorial Drive
Goldsboro, NC 27534

Mailing address

1704A Wayne Memorial Drive
Goldsboro, NC 27534
Phone (919) 580-1026

Other identifiers 1

IdentifierTypeStateIssuer
5901460MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050722000667 NC Practitioner - NephrologyPractitioner - Internal Medicine 2466489224 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Nephrology PAGroup PAC ID 3173519337, 3 clinicians

Practice addresses (Care Compare)

1704 A Wayne Memorial Dr
Goldsboro, NC 27534-2240
Phone (919) 580-1026

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200500739NCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne Memorial Hospital Inc CurrentSince May 1, 2010 Accepting new patients
Carolina Nephrology PA Nephrology CurrentSince Aug 1, 2005 Accepting new patients
Wayne Memorial Hospital Inc CurrentSince May 1, 2010 Accepting new patients

Locations

331 North Blvd
Ste 40
Clinton, NC 28328
Phone (919) 580-1026

1704 Wayne Memorial Dr
#A
Goldsboro, NC 27534
Phone (919) 580-9840

1704A Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 580-1026

2700 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 731-6060

Interoperability endpoints

  • Direct secure messaging: ajay.shreenath@direct.davitaphysiciansolutions.com

Organizations & group practices 3

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

Hospital & facility affiliations 6

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202256000000",
    "number": "1790879997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704A WAYNE MEMORIAL DRIVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-1026",
            "fax_number": "919-580-1027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704A WAYNE MEMORIAL DRIVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-1026",
            "fax_number": "919-580-1027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHREENATH",
        "first_name": "AJAY",
        "middle_name": "IYENGAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "200500739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901460",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.