NPIMap

Organization Active NPI

Pensacola Nephrology, PA

Doing business as Renalus Center for Kidney Care

  • Nephrology Physician
  • Fort Walton Beach, FL
National Provider Identifier
1871535955
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PENSACOLA NEPHROLOGY, PA
Doing business as
Renalus Center for Kidney Care
Practice address
319 Green Acres Rd Ste 103
Fort Walton Beach, FL 32547-1170
Phone
(850) 862-2385
Fax
(850) 862-0482
NPI assigned
Jun 12, 2006
Last updated
Feb 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PENSACOLA NEPHROLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Justin Dansby
Title
Cfo
Phone
(850) 444-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

319 Green Acres Rd Ste 103
Fort Walton Beach, FL 32547-1170

Mailing address

PO Box 11037
Pensacola, FL 32524-1037
Phone (850) 444-4700

Other identifiers 13

IdentifierTypeStateIssuer
0358OtherFLMED3000/HEALTH 1ST NETWOR
256870503MedicaidFL
256870508MedicaidFL
99659OtherFLBCBS OF FLORIDA
256870504MedicaidFL
256870501MedicaidFL
256870506MedicaidFL
256870507MedicaidFL
529904030MedicaidAL
CF9776OtherRR MEDICARE
256870500MedicaidFL
256870502MedicaidFL
256870505MedicaidFL

Other names 1

  • Renalus Center for Kidney Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pensacola Nephrology PA15 organizations share this tax ID, including this one
Part of
Pensacola Nephrology PA

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1871535955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11037",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241037",
            "telephone_number": "850-444-4700",
            "fax_number": "850-444-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 GREEN ACRES RD STE 103",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471170",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA NEPHROLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENSACOLA NEPHROLOGY, PA",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "DANSBY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-444-7000"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED3000/HEALTH 1ST NETWOR",
            "identifier": "0358",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870503",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870508",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "99659",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870504",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870501",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870506",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870507",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529904030",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CF9776",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870502",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256870505",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renalus Center for Kidney Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.