SOUTHSIDE KIDNEY SPECIALISTS
NPI 1033130026
Internal Medicine - Nephrology in Petersburg, VA

Q: What is Southside Kidney Specialists's NPI number?

The NPI number for Southside Kidney Specialists is 1033130026. It was assigned to this organization in the NPPES registry on July 22, 2006.

Q: What is Southside Kidney Specialists's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Active since July 22, 2006

3400 S CRATER RD, SUITE B, PETERSBURG, VA 23805(804) 733-6960(804) 733-3880 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Southside Kidney Specialists NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHSIDE KIDNEY SPECIALISTS (NPI 1033130026) is a healthcare organization registered as a nephrology in Petersburg, Virginia and active in the NPI registry since July 2006. The organization lists Vijaya Lakshmi Chirumamilla, President, as its authorized official.

NPPES Registry Identity

NPI1033130026

Entity TypeOrganization

Primary Taxonomy207RN0300X

Legal Business NameSOUTHSIDE KIDNEY SPECIALISTS

Location Address3400 S CRATER RD, SUITE BPetersburg, VA 23805-9211

Mailing Address3400 S Crater Rd, Suite BPetersburg, VA 23805-9211 · (804) 733-6960 · Fax (804) 733-3880

Phone(804) 733-6960

Fax(804) 733-3880

Organization SubpartNo

Authorized OfficialVijaya Lakshmi ChirumamillaPresident · (804) 733-6960

Enumeration DateJuly 22, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1033130026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

Definition

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.

3400 S CRATER RD, Petersburg, VA 23805

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southside Kidney Specialists is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 6 clinicians reassign Medicare billing to Southside Kidney Specialists, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Vijaya Chirumamilla, M.D.

Nephrology

NPI 1194773994

3400 S CRATER RD SUITE B
Petersburg, VA 23805

(804) 733-6960

✔ PECOSSame address

Sudhakar Relton, MD

Nephrology

NPI 1710944434

3400 S CRATER RD
Petersburg, VA 23805

(804) 733-6960

✔ PECOSSame address

Terri Jordan, N.P.,

Nurse Practitioner

NPI 1134175979

919 E MAIN ST STE 1000
Richmond, VA 23219

(804) 729-6904

✔ PECOS✔ Accepts Medicare25 mi

Hasan Iftikhar, MD

Nephrology

NPI 1407231152

937 S MAIN ST
Farmville, VA 23901

(434) 414-3990

✔ PECOS✔ Accepts Medicare57 mi

Mary Rose Jayme, NURSE PRACTITIONER

Nurse Practitioner

NPI 1033566153

200 E 5TH ST
Chase City, VA 23924

(434) 372-0900

✔ PECOS✔ Accepts Medicare66 mi

Folatomi Agbe-Davies, M.D.

Nephrology

NPI 1073805891

663 LANIER PARK DR
Gainesville, GA 30501

(678) 904-4742

✔ PECOS✔ Accepts Medicare412 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southside Kidney Specialists's NPI number?

The NPI number for Southside Kidney Specialists is 1033130026. It was assigned to this organization in the NPPES registry on July 22, 2006.

Where is Southside Kidney Specialists located?

Southside Kidney Specialists is located at 3400 S Crater Rd Suite B, Petersburg, VA 23805. The listed phone number is (804) 733-6960.

What is Southside Kidney Specialists's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Southside Kidney Specialists enrolled in Medicare?

Yes. Southside Kidney Specialists is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southside Kidney Specialists?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Southside Kidney Specialists. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nephrology (4) and Nurse Practitioner (2). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southside Kidney Specialists was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.