DRG Fayette PLLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

DRG FAYETTE PLLC

Practice address

225 Community Drive
Off Hwy 61
Fayette, MS 39069

Phone

(601) 786-6676

Fax

(601) 786-6678

NPI assigned

Dec 12, 2007

Last updated

Jan 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tunde Olutade

Title

Member

Phone

(601) 899-3340

Specialties & licenses 1

Addresses

Other names 1

• Diversified Renal Group Fayette, PLLC Other name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• DRG Fayette, PLLC

  dba Diversified Renal Group Home Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fayette, MS
  • NPI 1649556721

  8820178049

  Same PAC ID

Tax ID family

Diversified Renal Group Fayette PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• DRG Fayette, PLLC

  dba Diversified Renal Group Home Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fayette, MS
  • NPI 1649556721
  NPD tax ID

Practitioners 1

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.

• Babatunde Olutade, MD

  • Nephrology Physician
  • Jackson, MS
  • NPI 1316050750
  NPD

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1891978953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5903 RIDGEWOOD RD",
            "address_2": "SUITE 340",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113700",
            "telephone_number": "601-899-3340",
            "fax_number": "601-899-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 COMMUNITY DRIVE",
            "address_2": "OFF HWY 61",
            "city": "FAYETTE",
            "state": "MS",
            "postal_code": "39069",
            "telephone_number": "601-786-6676",
            "fax_number": "601-786-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRG FAYETTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "OLUTADE",
        "authorized_official_first_name": "TUNDE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-899-3340"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversified Renal Group Fayette, PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Chambliss Counseling Services PLLC
• Sharron Daneka Chambliss, LPC, NCC
• Crystal S Cook, CFNP
• Tiffany Nicole Cruel, LPC
• Gabrielle Doss
• DRG Fayette, PLLC (Diversified Renal Group Home Dialysis)
• John Ellis Evans, M.D.
• Evers Personal Care & Respite Services LLC
• Fayette Express Pharmacy
• Georgene Ferrie, LMT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fayette, MS
• Providers in Fayette, MS by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.