Maryland Kidney Care LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

MARYLAND KIDNEY CARE LLC

Practice address

826 Washington Rd Ste 205
Westminster, MD 21157-5780

Phone

(410) 386-9099

Fax

(410) 386-9098

NPI assigned

Nov 6, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Ikenna Ezumba, MDNPI 1619167202

Title

Director

Phone

(443) 835-8683

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19338/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Ikenna I Ezumba, MD

  • Nephrology Physician
  • Westminster, MD
  • NPI 1619167202

  MD, Nephrology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1982172169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON RD STE 205",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211575780",
            "telephone_number": "410-386-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON RD STE 205",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211575780",
            "telephone_number": "410-386-9099",
            "fax_number": "410-386-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND KIDNEY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-06",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "EZUMBA",
        "authorized_official_first_name": "IKENNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-835-8683",
        "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": []
}

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• All providers in Westminster, MD
• Nephrology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; 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.