DIVERSIFIED RENAL GROUP LLC (NPI# 1184792038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184792038 |
| Entity Type | Organization |
| Organization Name | DIVERSIFIED RENAL GROUP LLC |
| Practice Address |
5903 Ridgewood Rd Ste 340 Jackson MS 39211 |
| Mailing Address |
Po Box 2057 Ridgeland MS 39158 |
| Practice Telephone | 6018993340 |
| Practice Fax Number | 6018993343 |
| Mailing Telephone | 6018993340 |
| Mailing Fax Number | 6018993343 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-04-25 |
| Authorized Official Name | GARY M DAVIS (MEMBER) |
| Authorized Official Telephone | 6018993340 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09014813 | 05 |
| Street Address |
5903 RIDGEWOOD RD STE 340 |
| City | JACKSON |
| State | MS |
| Zip Code | 39211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255330163 | Select Specialty Hospital - Jackson Inc | Long Term Care Hospital | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2005-07-21 |
| 1083079545 | Genevieve Celeste Garrett | Social Worker | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2015-12-28 |
| 1528443975 | Medical Assurance LLC | Internal Medicine | 5903 Ridgewood Rd, Suite 320, Jackson, MS 39211-3700 | 2015-07-28 |
| 1255719068 | Medical Care Alliance LLC | Clinic/Center | 5903 Ridgewood Rd, Suite 310, Jackson, MS 39211-3700 | 2015-05-13 |
| 1881087427 | Infusion Center Pharmacy | Clinic/Center | 5903 Ridgewood Rd, Suite 110, Jackson, MS 39211-3700 | 2015-03-06 |
| 1063786036 | The Pain Clinic of Mississippi, Pllc | Pain Medicine | 5903 Ridgewood Rd, Suite 440, Jackson, MS 39211-3700 | 2012-03-08 |
| 1720213069 | Reddix Medical Group | Clinic/Center | 5903 Ridgewood Rd, Suite 310, Jackson, MS 39211-3700 | 2009-05-15 |
| 1154569853 | Leslie Rooks | Registered Nurse | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2009-02-03 |
| 1720258403 | Neurosurgical Associates | Neurological Surgery | 5903 Ridgewood Rd, Suite 101, Jackson, MS 39211-3700 | 2008-03-10 |
| 1508036575 | Heart Associates of Central Ms | Internal Medicine | 5903 Ridgewood Rd, Suite230, Jackson, MS 39211-3700 | 2008-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760092878 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 5722 I-55 N Frontage Road, Jackson, MS 39211 | 2020-08-04 |
| 1548881048 | Gloria Dansby-giles | Counselor | 4500 Interstate 55, North; Suite 220, Jackson, MS 39211 | 2020-05-06 |
| 1821628223 | Alice Powell Taylor | St. Dominic Weight Loss Solutions, 3800 Interstate 55 North Frontage Road Suite 102, Jackson, MS 39211 | 2020-01-24 | |
| 1356980643 | Bethany Powers | Pharmacist | 4910 Interstate 55 North Frontage Rd, Jackson, MS 39211 | 2020-01-03 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1285108357 | Eric Wood | Counselor | 4623 Maurey Rd, Jackson, MS 39211 | 2019-01-11 |
| 1649758301 | Isluv Robertson | Registered Nurse | 1405 E Northside Dr, Jackson, MS 39211 | 2018-08-03 |
| 1659863066 | Jonbrighton Childs Russell | Student in an Organized Health Care Education/Training Program | 4343 Dalrymple Ct, Jackson, MS 39211 | 2018-05-31 |
| 1225557598 | Regina Ann Day | Dietitian, Registered | 3800 I 55 North Frontage Road, Jackson, MS 39211 | 2017-09-18 |
| 1023558525 | Agilitas Usa Inc | Clinic/Center | 120 District Blvd E, Suite D102, Jackson, MS 39211 | 2017-03-02 |
| Find all providers in zip 39211 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942813506 | Uma Mahesh Reddy Avula | Internal Medicine | 2500 N State St Rm L-504, Jackson, MS 39216-4500 | 2020-08-24 |
| 1649555467 | Cardiac Renal & Vascular Associates PC | Internal Medicine | 5240 Robinson Road Ext, Jackson, MS 39204-4276 | 2011-10-12 |
| 1821151598 | Kavita Luthra | Internal Medicine | 900 E Michigan Ave Ste 104, Jackson, MI 49201-2490 | 2006-12-18 |
| 1801971908 | Murphy S Martin | Internal Medicine | 1513 Lakeland Drive, Suite 200, Jackson, MS 39216 | 2006-10-26 |
| 1033124904 | Sybil F Raju | Internal Medicine | 1400 Woodrow Wilson Avenue, Va Hospital, Jackson, MS 39216 | 2006-07-29 |
| 1568489417 | Nosratollah Ghaemmaghami | Internal Medicine | 381 Medical Drive, Jackson, MS 39216 | 2006-07-16 |
| 1629007406 | Kent Alan Kirchner | Internal Medicine | 1500 E. Woodrow Wilson Blvd, Jackson, MS 39216-5199 | 2006-07-02 |
| 1912519364 | Rashmi Verma | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-18 |
| 1457844599 | Kidney & Hypertension Specialists of Jackson Piketon and Chillicothe L | Internal Medicine | 3 Acy Ave, Jackson, OH 45640-9561 | 2018-06-13 |
| 1104331511 | Aldo Torres | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2017-12-07 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.