Nice Nephrology, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

NICE NEPHROLOGY, LLC

Practice address

555 N New Ballas Rd Ste 210
Saint Louis, MO 63141-6844

Phone

(314) 993-4949

NPI assigned

Dec 7, 2020

Organization subpart

No

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

Authorized official

Name

Maisa A Nazzal, MDNPI 1295991073

Title

Owner / MD

Phone

(314) 993-4949

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 6

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

• Maisa A Nazzal, M.D.

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1295991073
  Medicare reassignment NPD Authorized official
• Stacie D Detmer, FNP

  • Family Nurse Practitioner
  • Fenton, MO
  • NPI 1235380064
  NPD (past)
• William Frederick Feldner, D.O.

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1922085539
  NPD (past)
• Sri Devi Kolli, M.D.

  • Internal Medicine Physician
  • Fenton, MO
  • NPI 1558308361
  NPD (past)
• Kyle C Moylan, MD

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Saint Louis, MO
  • NPI 1124052808
  NPD (past)
• Janelle Roethemeyer, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1417938929
  NPD (past)

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1801492855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 315",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630220315",
            "telephone_number": "314-432-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N NEW BALLAS RD STE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416844",
            "telephone_number": "314-993-4949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Bowles Ave Ste 450",
            "address_purpose": "LOCATION",
            "city": "Fenton",
            "state": "MO",
            "postal_code": "630260562",
            "country_code": "US",
            "telephone_number": "314-993-4949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NICE NEPHROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "NAZZAL",
        "authorized_official_first_name": "MAISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / MD",
        "authorized_official_telephone_number": "314-993-4949",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Buqing Ni, MD
• Christopher W Niblett
• Laura Bo-Khia Niboh, WHNP-BC
• Ellen Margaret Nicastro, MD
• Tristen Michael Niccum, EMT
• Kathleen Nicely
• Demitra Marie Nichoalds, CRNA
• Nicholas P Kamakas, DDS
• Katie Lynn Nicholls
• Amber L Nichols

• Nephrology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nephrology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.