Organization Active NPI

Georgia Kidney Institute LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Macon, GA
National Provider Identifier
1962825844
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
055819 Issued in GA
Legal business name
GEORGIA KIDNEY INSTITUTE LLC
Practice address
1625 Hardeman Ave
Macon, GA 31201-1417
Phone
(478) 257-5200
NPI assigned
Jan 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2022

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

Authorized official

Name
Dr. Morufu Alausa, MDNPI 1730135955
Title
Chief Medical Director
Phone
(815) 714-7171

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
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 055819 GA Primary

Addresses

Primary practice location

1625 Hardeman Ave
Macon, GA 31201-1417

Mailing address

PO Box 3134
Joliet, IL 60434-3134
Phone (815) 714-7171

Other identifiers 2

IdentifierTypeStateIssuer
1962825844OtherGANPI
003124971AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140410002295 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 1658503321 Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

1625 Hardeman Ave
Macon, GA 31201
Phone (478) 474-2114

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1962825844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3134",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604343134",
            "telephone_number": "815-714-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 HARDEMAN AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312011417",
            "telephone_number": "478-257-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA KIDNEY INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "ALAUSA",
        "authorized_official_first_name": "MORUFU",
        "authorized_official_title_or_position": "CHIEF MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "815-714-7171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "055819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1962825844",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124971A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.