Kidney Care Clinic Pllc is a medicare enrolled "Internal Medicine - Nephrology" provider in Cookeville, Tennessee. Their current practice location is
427 N Willow Ave Ste C, Cookeville, Tennessee. You can reach out to their office (for appointments etc.) via phone at
(931) 650-0076.
Kidney Care Clinic Pllc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Kidney Care Clinic Pllc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1932779170.
Healthcare Provider's Profile
| Full Name | Kidney Care Clinic Pllc |
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| Type | Facility |
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| Speciality | Internal Medicine - Nephrology |
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| Location | 427 N Willow Ave Ste C, Cookeville, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1932779170
- Provider Enumeration Date: 06/29/2021
- Last Update Date: 08/11/2022
Medicare PECOS Information:
- PECOS PAC ID: 6406244599
- Enrollment ID: O20211021002535
Medical Identifiers
Medical identifiers for Kidney Care Clinic Pllc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1932779170 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133VN1004X | Dietitian, Registered - Nutrition, Pediatric | (* (Not Available)) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Kidney Care Clinic Pllc acts as a billing entity for following providers:
| Provider Name | Zaid Brifkani |
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| Provider Type | Practitioner - Nephrology |
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| Provider Identifiers | NPI Number: 1457516163
PECOS PAC ID: 6507036092
Enrollment ID: I20110818000526 |
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| Provider Name | Taylor Adell Russell |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1801560941
PECOS PAC ID: 3072910843
Enrollment ID: I20210921001874 |
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| Provider Name | Shawn Billingsley |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1508530734
PECOS PAC ID: 2860899382
Enrollment ID: I20210927002202 |
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| Provider Name | Rohan Kataria |
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| Provider Type | Practitioner - Nephrology |
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| Provider Identifiers | NPI Number: 1821587353
PECOS PAC ID: 8527319334
Enrollment ID: I20230419003090 |
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| Provider Name | Gabino Manuel Maza Rodas |
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| Provider Type | Practitioner - Nephrology |
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| Provider Identifiers | NPI Number: 1710484241
PECOS PAC ID: 8527316892
Enrollment ID: I20230424002389 |
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| Provider Name | Stephanie Ann Legin |
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| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
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| Provider Identifiers | NPI Number: 1124448949
PECOS PAC ID: 9234595430
Enrollment ID: I20230512002240 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kidney Care Clinic Pllc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kidney Care Clinic Pllc
427 N Willow Ave Ste C,
Cookeville, TN 38501-2354
Ph: (931) 650-0076 | Kidney Care Clinic Pllc
427 N Willow Ave Ste C,
Cookeville, TN 38501-2354
Ph: (931) 650-0076 |
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