NPIMap

Organization Active NPI

North Texas Kidney Disease Associates

  • Nephrology Physician
  • Lewisville, TX
National Provider Identifier
1821169632
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Practice address
1600 Waters Ridge Dr Ste a
Lewisville, TX 75057-6039
Phone
(972) 219-0558
Fax
(214) 466-7237
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Sirena Martin
Title
Practice Manager
Phone
(214) 466-7230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1600 Waters Ridge Dr Ste a
Lewisville, TX 75057-6039

Mailing address

1600 Waters Ridge Dr Ste a
Lewisville, TX 75057-6039
Phone (972) 219-0558

Other identifiers 1

IdentifierTypeStateIssuer
146883702MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001106 TX Part B Supplier - Clinic/Group Practice 0941296107 Receives reassigned benefits from 26 practitioners
5 other NPIs on this enrollment
Practice locations: Plano, TX; North Richland Hills, TX; Lewisville, TX; Frisco, TX; Fort Worth, TX; Flower Mound, TX; Denton, TX; Carrollton, TX…

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0691161North Texas Kidney Disease1600 Waters Ridge Drive Suite a, Lewisville, TX 75057Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
North TX Kidney Disease10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4333 N Josey Ln
Ste 205
Carrollton, TX 75010
Phone (214) 663-1397

4370 Medical Arts Dr
Ste 210
Flower Mound, TX 75028
Phone (469) 645-0202

1600 Waters Ridge Dr
Ste 210
Lewisville, TX 75057

6331 Boulevard 26
Ste 220
North Richland Hills, TX 76180
Phone (817) 628-0284

1600 Coit Rd
Ste 300
Plano, TX 75075
Phone (972) 295-9660

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1821169632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WATERS RIDGE DR STE A",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576039",
            "telephone_number": "972-219-0558",
            "fax_number": "214-466-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WATERS RIDGE DR STE A",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576039",
            "telephone_number": "972-219-0558",
            "fax_number": "214-466-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH TEXAS KIDNEY DISEASE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SIRENA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "214-466-7230"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146883702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.