Durham Nephrology Associates PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

DURHAM NEPHROLOGY ASSOCIATES PA

Practice address

4419 Ben Franklin Blvd
Durham, NC 27704-2147

Phone

(919) 477-3005

Fax

(919) 477-5526

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles Ian Cooperberg, MDNPI 1073530655

Title

President

Phone

(919) 477-3005

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Durham Nephrology Other name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

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

• Charles Ian Cooperberg, MD

  • Nephrology Physician
  • Durham, NC
  • NPI 1073530655
  Medicare reassignment Care Compare group NPD Authorized official
• Romin Bonakdar

  • Nephrology Physician
  • Durham, NC
  • NPI 1003236787
  Medicare reassignment Care Compare group NPD
• Tomasz Ryszard Gawecki, MD

  • Nephrology Physician
  • Durham, NC
  • NPI 1922023712
  Medicare reassignment Care Compare group NPD
• Nawal Habib, M.D.

  • Nephrology Physician
  • Durham, NC
  • NPI 1346692969
  Medicare reassignment Care Compare group NPD
• Amarnath A Kathresal, M.D.

  • Nephrology Physician
  • Durham, NC
  • NPI 1033194402
  Medicare reassignment Care Compare group NPD
• Elynelle J Moaje, NP

  • Acute Care Nurse Practitioner
  • Durham, NC
  • NPI 1346890779
  Medicare reassignment Care Compare group NPD
• Samuel Theodore Shaikewitz, MD

  • Nephrology Physician
  • Durham, NC
  • NPI 1447276381
  Medicare reassignment Care Compare group NPD
• Kimberly Quail Atwood, RD, PA-C

  • Physician Assistant
  • Durham, NC
  • NPI 1700161593
  Medicare reassignment Care Compare group
• Caitlin Drennan Monaco, PA-C

  • Physician Assistant
  • Garner, NC
  • NPI 1366198491
  Medicare reassignment Care Compare group
• Thomas Ramos

  • Physician Assistant
  • Durham, NC
  • NPI 1285241042
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1962583203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4419 BEN FRANKLIN BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042147",
            "telephone_number": "919-477-3005",
            "fax_number": "919-477-5526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 BEN FRANKLIN BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042147",
            "telephone_number": "919-477-3005",
            "fax_number": "919-477-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DURHAM NEPHROLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "COOPERBERG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-477-3005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0166C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890166C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG4698",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Durham Nephrology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Durham Nephrology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Durham Internal Medicine Associates, P.a.
• Durham Lifestyle Management LLC
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• Durham Neurology PLLC
• Durham Operator LLC
• Durham Pediatric Psychology, P.a.
• Durham Physicians, PA
• Durham Psych PLLC

• Nephrology Physician in Durham, NC
• Providers in Durham, NC by specialty
• Nephrology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.