NPIMap

Organization Active NPI

Kidney Consultants of Michigan PC

  • Nephrology Physician
  • Roseville, MI
National Provider Identifier
1932396496
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY CONSULTANTS OF MICHIGAN PC
Practice address
25710 Kelly Rd Ste 1
Roseville, MI 48066
Phone
(586) 772-2600
Fax
(586) 772-5289
NPI assigned
Sep 28, 2007
Last updated
Feb 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Dr. Abdul R Effendi, MDNPI 1881647584
Title
Owner
Phone
(586) 772-2600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

25710 Kelly Rd Ste 1
Roseville, MI 48066

Mailing address

25710 Kelly Rd Ste 1
Roseville, MI 48066-4959
Phone (586) 772-2600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000846 MI Part B Supplier - Clinic/Group Practice 2163464520 Receives reassigned benefits from 10 practitioners
Practice locations: Grosse Pointe, MI; Roseville, MI; Sterling Heights, MI; Troy, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1932396496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD STE 1",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664959",
            "telephone_number": "586-772-2600",
            "fax_number": "586-772-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD STE 1",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-772-2600",
            "fax_number": "586-772-5289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CONSULTANTS OF MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "EFFENDI",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-772-2600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.