NPIMap

Organization Active NPI

Fredericksburg Nephrology Associates, Inc.

  • Nephrology Physician
  • Fredericksburg, VA
National Provider Identifier
1861583510
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
FREDERICKSBURG NEPHROLOGY ASSOCIATES, INC.
Practice address
101 Park Hill Dr
Fredericksburg, VA 22401-3357
Phone
(540) 371-3010
Fax
(540) 899-9821
NPI assigned
Sep 27, 2006
Last updated
Nov 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Authorized official

Name
Tammy Provencher, PROVENCHER
Title
Credentialing Supervisor
Phone
(540) 371-3010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X VA Primary

Addresses

Primary practice location

101 Park Hill Dr
Fredericksburg, VA 22401-3357

Mailing address

101 Park Hill Dr
Fredericksburg, VA 22401-3357
Phone (540) 371-3010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629000253 VA Part B Supplier - Clinic/Group Practice 6002892197 Receives reassigned benefits from 13 practitioners
Practice locations: Fredericksburg, VA

National Provider Directory

National Provider Directory

Locations

101 Park Hill Dr
Fredericksburg, VA 22401
Phone (540) 371-3010

4604 Spotsylvania Pkwy
Ste 335
Fredericksburg, VA 22408
Phone (540) 898-4056

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1861583510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK HILL DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013357",
            "telephone_number": "540-371-3010",
            "fax_number": "540-899-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PARK HILL DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013357",
            "telephone_number": "540-371-3010",
            "fax_number": "540-899-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICKSBURG NEPHROLOGY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "540-371-3010",
        "authorized_official_credential": "PROVENCHER"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.