KIDNEY CARE DIRECT, LLC – Nephrology Physician, NPI 1396143343
Nephrology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KIDNEY CARE DIRECT, LLC
424 E CENTRAL BLVD STE 101
ORLANDO, FL 328011923
Phone: (407) 906-5231
Type: Mailing
424 E CENTRAL BLVD STE 721
ORLANDO, FL 328011923
Phone: (407) 906-5231
Type: Mailing
495 Thomas Jones Way Ste 300
Exton, PA 193412553
Phone: (407) 906-5231
Type: Location
4714 16th Ave Fl 4
Brooklyn, NY 112041197
Phone: (407) 906-5231
Type: Location
3619 Park East Dr Ste 110
Beachwood, OH 441224312
Phone: (407) 906-5231
Type: Location
800 Roosevelt Rd Ste E320
Glen Ellyn, IL 601375893
Phone: (630) 942-1111
Type: Location
13295 Illinois St Ste 210
Carmel, IN 460323021
Phone: (407) 906-5231
Type: Location
16545 Southwest Fwy Ste 275
Sugar Land, TX 774793601
Phone: (407) 906-5231
Fax: (877) 991-9077
Type: Location
1601 CLINT MOORE RD
SUITE 160
BOCA RATON, FL 33487
Phone: (732) 654-6523
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-06-26
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-01-31 (866 days ago).
Enrollment records
7
Earliest due date
2024-01-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20150402000144 | O | Clinic/Group Practice | NJ | 2024-01-31 |
| O20151020001239 | O | Clinic/Group Practice | FL | TBD |
| O20200520001892 | O | Clinic/Group Practice | PA | 2026-02-28 |
| O20200520003718 | O | Clinic/Group Practice | OH | 2026-03-31 |
| O20200526003232 | O | Clinic/Group Practice | TX | 2026-04-30 |
| O20200626000309 | O | Clinic/Group Practice | MO | 2026-05-31 |
| O20200626002330 | O | Clinic/Group Practice | TN | 2026-06-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32801)
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