Angelo Kidney Connection, PLLC

Primary specialty

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

License

8643 Issued in TX

Legal business name

ANGELO KIDNEY CONNECTION, PLLC

Practice address

2901 Sherwood Way
Suite 100
San Angelo, TX 76901-3586

Phone

(326) 617-2496

Fax

(325) 617-2497

NPI assigned

Feb 5, 2008

Last updated

Sep 10, 2010By 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

Ms. Melanie L. Baumgartner, RN

Title

Administrator/Ceo

Phone

(325) 617-2496

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Angelo Kidney ConnectionCCN 672594

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Nov 18, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

Locations

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.

• Elmoutaz Tawfig Mousa, M.D.

  • Nephrology Physician
  • Lubbock, TX
  • NPI 1124287735
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Elmoutaz Tawfig Mousa, M.D.

  • Nephrology Physician
  • Lubbock, TX
  • NPI 1124287735

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1952589665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 61074",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769061074",
            "telephone_number": "325-617-2496",
            "fax_number": "325-617-2497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 SHERWOOD WAY",
            "address_2": "SUITE 100",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013586",
            "telephone_number": "326-617-2496",
            "fax_number": "325-617-2497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELO KIDNEY CONNECTION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "325-617-2496",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "8643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948945",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelo Endodontics PA
• Angelo Eye Associates PA (Advanced Eye Care)
• Angelo General & Thoracic Surgery
• Angelo Healthcare Services, Inc.
• Angelo Kidney Connection at Home, PLLC
• Angelo Nephrology Associated
• Angelo Oral & Maxillofacial Surgery, P. a.
• Angelo Pharmacy Corp (Angelo Pharmacy)
• Angelo Pharmacy Corp
• Angelo Physical Therapy and Wellness

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Angelo, TX
• Providers in San Angelo, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.