Georgia Kidney Institute LLC

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

Last updated

May 25, 2022By 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

Dr. Morufu Alausa, MDNPI 1730135955

Title

Chief Medical Director

Phone

(815) 714-7171

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962825844. Details of each certification follow.

• CCN 112887 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 112887

Legal name

GEORGIA KIDNEY INSTITUTE

Certification status

Active

Provider type (POS)

End-stage renal disease facility

Participating since

Jul 16, 2014

Last certification

Apr 28, 2021

Ownership / control type

For Profit

Multi-facility organization

DCC DIALYSIS CARE CENTER

Facility address

1625 Hardeman Avenue
Macon, GA 31201

Practitioners 3

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.

• Morufu Olatunji Alausa, M.D

  • Nephrology Physician
  • Joliet, IL
  • NPI 1730135955
  NPD (past) Authorized official
• William S Barnes, MD

  • Orthopaedic Surgery Physician
  • Macon, GA
  • NPI 1972543973
  NPD
• Brianna Goodie, RN

  • Registered Nurse
  • Macon, GA
  • NPI 1699514885
  NPD

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": [],
    "endpoints": [],
    "other_names": []
}

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• Georgia Magnetic Imaging Center LTD
• Georgia Medical Devices, LLC
• Georgia Medical Equipment & Supplies of Macon, Inc
• Georgia Medical Equipment, LLC
• Georgia Medical Group, LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Macon, GA
• Providers in Macon, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• 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; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.