Diversified Renal Group LLC
NPI 1184792038ActiveOrganization· Internal Medicine, Nephrology· Jackson, MS
Internal Medicine, Nephrology in Jackson, Mississippi, registered in NPPES in November 2006. The authorized official on file is Gary M. Davis, MD, Member. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1184792038 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 30, 2006 |
| Last updated in NPPES | Apr 25, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine, Nephrology Primary | 207RN0300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MS) |
|---|
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