Kidney Care Home SC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

KIDNEY CARE HOME SC

Practice address

6125 Green Bay Rd Ste 200
Kenosha, WI 53142-2945

Phone

(262) 564-8636

Fax

(262) 564-8637

NPI assigned

Jul 6, 2022

Organization subpart

No

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

Authorized official

Name

Ganesh N Pulla, M.D.NPI 1679620918

Title

Owner/Medical Director

Phone

(262) 564-8636

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Ganesh N Pulla, M.D

  • Nephrology Physician
  • Kenosha, WI
  • NPI 1679620918
  NPD Authorized official

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657065600000",
    "number": "1831822956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD STE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422945",
            "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 STE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422945",
            "telephone_number": "262-564-8636",
            "fax_number": "262-564-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE HOME SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "PULLA",
        "authorized_official_first_name": "GANESH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "262-564-8636",
        "authorized_official_credential": "M.D."
    },
    "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": "32537500",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "6125 Green Bay Rd Ste 200",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531422945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Muhammad S Khan, MD
• Seema Khan, MD
• Kevin A Khater, MD, PHD
• Farheen Khatoon, DDS
• Kid Power, LLC
• Kidney Replacement Therapies, SC
• Ali J Kilic, MD
• Tom S. Kim, M.D.
• Kindred Living of Kenosha, LLC
• Kindred Nursing and Rehab Kenosha North

• Nephrology Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Nephrology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.