DIVERSIFIED RENAL GROUP LLC
NPI 1184792038
Internal Medicine - Nephrology in Jackson, MS

Q: What is Diversified Renal Group LLC's NPI number?

The NPI number for Diversified Renal Group LLC is 1184792038. It was assigned to this organization in the NPPES registry on November 30, 2006.

Q: What is Diversified Renal Group LLC's specialty?

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

Active since November 30, 2006

5903 RIDGEWOOD RD, STE 340, JACKSON, MS 39211(601) 899-3340(601) 899-3343 Get Directions Write a Review

NPPES record last updated: April 25, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Diversified Renal Group Llc NPPES

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

DIVERSIFIED RENAL GROUP LLC (NPI 1184792038) is a healthcare organization registered as a nephrology in Jackson, Mississippi and active in the NPI registry since November 2006. The organization lists Gary M Davis, Member, as its authorized official.

NPPES Registry Identity

NPI1184792038

Entity TypeOrganization

Primary Taxonomy207RN0300X

Legal Business NameDIVERSIFIED RENAL GROUP LLC

Location Address5903 RIDGEWOOD RD, STE 340Jackson, MS 39211

Mailing AddressPo Box 2057Ridgeland, MS 39158 · (601) 899-3340 · Fax (601) 899-3343

Phone(601) 899-3340

Fax(601) 899-3343

Organization SubpartNo

Authorized OfficialGary M DavisMember · (601) 899-3340

Enumeration DateNovember 30, 2006

Last NPPES UpdateApril 25, 2008

✔ NPI 1184792038 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.

5903 RIDGEWOOD RD, Jackson, MS 39211

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Other Identifiers 2

Medicaid09014813MS

Medicare PINC02385MS

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)

Diversified Renal Group Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 5 clinicians reassign Medicare billing to Diversified Renal Group LLC, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Gary Davis, MD

Nephrology

NPI 1912065251

5903 RIDGEWOOD RD STE 340
Jackson, MS 39211

(601) 899-3340

✔ PECOS✔ Accepts Medicare0.1 mi

Babatunde Olutade, MD

Nephrology

NPI 1316050750

5903 RIDGEWOOD RD SUITE 340
Jackson, MS 39211

(601) 899-3340

✔ PECOS✔ Accepts Medicare0.1 mi

Hollye Johnson, MD

Nephrology

NPI 1700815321

6501 DOGWOOD VIEW PARKWAY SUITE A
Jackson, MS 39213

(601) 899-3340

✔ PECOS✔ Accepts Medicare3.3 mi

James Onyirimba, M.D.

Nephrology

NPI 1720475783

6501 DOGWOOD VIEW PKWY
Jackson, MS 39213

(601) 899-3340

✔ PECOS✔ Accepts Medicare3.3 mi

Kanieshia Mitchell, NP

Nurse Practitioner

NPI 1629614003

4500 13TH ST
Gulfport, MS 39501

(228) 867-4000

✔ PECOS✔ Accepts Medicare152 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 Diversified Renal Group LLC's NPI number?

The NPI number for Diversified Renal Group LLC is 1184792038. It was assigned to this organization in the NPPES registry on November 30, 2006.

Where is Diversified Renal Group LLC located?

Diversified Renal Group LLC is located at 5903 Ridgewood Rd Ste 340, Jackson, MS 39211. The listed phone number is (601) 899-3340.

What is Diversified Renal Group LLC's specialty?

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

Is Diversified Renal Group LLC enrolled in Medicare?

Yes. Diversified Renal Group LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Diversified Renal Group LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Diversified Renal Group LLC. 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 (1). Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Diversified Renal Group LLC was last updated on April 25, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.