Renal Rd WV LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

RENAL RD WV LLC

Practice address

1811 Coffman St
Barboursville, WV 25504-2023

Phone

(304) 617-4067

NPI assigned

Apr 22, 2021

Organization subpart

No

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

Authorized official

Name

Jillian Pate, MS RD CSR LDNPI 1245825223

Title

Owner

Phone

(304) 617-4067

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Practitioners 3

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

• Jillian Pate, MS, RD, CSR, LD

  • Renal Nutrition Registered Dietitian
  • Barboursville, WV
  • NPI 1245825223

  Multi-Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Lisa D Jones, RD, LD

  • Renal Nutrition Registered Dietitian
  • South Charleston, WV
  • NPI 1245225820
  Medicare reassignment Care Compare group NPD
• Jessica C Walden, MS, RD, LD, BBA

  • Registered Dietitian
  • Ona, WV
  • NPI 1760092084

  Dietitian, Registered

  Medicare reassignment NPD

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1881276665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 COFFMAN ST",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255042023",
            "telephone_number": "304-617-4067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 COFFMAN ST",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255042023",
            "telephone_number": "304-617-4067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL RD WV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "PATE",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-617-4067",
        "authorized_official_credential": "MS RD CSR LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "MR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1811 Coffman St",
            "city": "Barboursville",
            "state": "WV",
            "country_code": "US",
            "postal_code": "255042023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracie Reeves
• Marsha Reffitt
• Rebekah Reid
• Mary Lynn Reinhardt, FNP-BC
• Alliyah Reitnauer
• David Renner
• Caitlyn Rex
• Brittany Reynolds
• Kimberly Reynolds
• Lori Reynolds

• Registered Dietitian in Barboursville, WV
• Providers in Barboursville, WV by specialty
• Registered Dietitian in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.