NPIMap

Organization Active NPI

Delta Kidney Alliance LLC

  • Nephrology Physician
  • Greenville, MS
National Provider Identifier
1992276851
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
DELTA KIDNEY ALLIANCE LLC
Practice address
1997 N Medical Park Dr
Greenville, MS 38703-7268
Phone
(662) 335-4105
Fax
(662) 378-2879
NPI assigned
Dec 17, 2018
Last updated
Sep 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Authorized official

Name
Lisa Hearn
Title
Practice Manager
Phone
(662) 335-4105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

1997 N Medical Park Dr
Greenville, MS 38703-7268

Mailing address

1997 Medical Park Dr
Greenville, MS 38703-7268
Phone (662) 335-4105

Other practice location 1

220 N Pearman Ave
Cleveland, MS 38732-2634
Phone (662) 335-4105

Other practice location 2

20019 Highway 61
Rolling Fork, MS 39159-5204
Phone (662) 335-4105

Other practice location 3

2729 S Highway 65 82
Lake Village, AR 71653-6136
Phone (662) 335-4105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190402000570 MS Part B Supplier - Clinic/Group Practice 3870834856 Receives reassigned benefits from 6 practitioners
Practice locations: Greenville, MS
O20190812003280 AR Part B Supplier - Clinic/Group Practice 3870834856 Receives reassigned benefits from 2 practitioners
Practice locations: Lake Village, AR; Helena, AR

National Provider Directory

National Provider Directory

Locations

505 Saint Mary St
Lake Village, AR
Phone (870) 265-3837

220 N Pearman Ave
Cleveland, MS 38732
Phone (662) 846-6943

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1992276851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1997 MEDICAL PARK DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037268",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1997 N MEDICAL PARK DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037268",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 N Pearman Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "MS",
            "postal_code": "387322634",
            "country_code": "US",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20019 Highway 61",
            "address_purpose": "LOCATION",
            "city": "Rolling Fork",
            "state": "MS",
            "postal_code": "391595204",
            "country_code": "US",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2729 S Highway 65 82",
            "address_purpose": "LOCATION",
            "city": "Lake Village",
            "state": "AR",
            "postal_code": "716536136",
            "country_code": "US",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DELTA KIDNEY ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A",
        "authorized_official_last_name": "HEARN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "662-335-4105"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.