CLINICAL RENAL ASSOCIATES, LLC
Complete NPI Record 1689620254
Internal Medicine - Nephrology in Upland, PA

Active since May 25, 2006CLIA 39D0698439 · Microscopy

30 MEDICAL CENTER BLVD, SUITE 303, UPLAND, PA 19013(610) 872-8501(610) 872-5188 Get Directions

NPPES record last updated: November 30, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Complete NPI Dataset

This page contains the complete raw NPPES record for Clinical Renal Associates, Llc (NPI 1689620254), an internal medicine organization in Upland, PA. All 55 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1689620254: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: CLINICAL RENAL ASSOCIATES, LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 850 W RIO SALADO PKWY STE 201: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: TEMPE: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: AZ: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 852813812: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 4804808330: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 4806106198: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 30 MEDICAL CENTER BLVD: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 303: The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: UPLAND: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: PA: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 190133955: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6108728501: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6108725188: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/25/2006: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/30/2023: The date that a record was last updated or changed.
Authorized Official Last Name: MARCUS: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ROY: The first name of the authorized official.
Authorized Official Middle Name: G.: The middle name of the authorized official.
Authorized Official Title or Position: CHIEF OPERATING OFFICER: The title or position of the authorized official.
Authorized Official Telephone Number: 6108728501: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RN0300X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 0032975000: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 1: PERSONAL CHOICE: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 2: CF3534: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 2: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 2: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 2: RAIL ROAD MEDICARE: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 3: 0032975000: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 3: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 3: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 3: AMERIHEALTH: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 4: 045319: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 4: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 4: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 4: KEYSTONE MERCY: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 5: 000760867-0013: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 5: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 5: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 6: 110372: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 6: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 6: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 6: BCBS PA: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Credential Text: M.D.: The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 11/30/2023: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 14

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

196 W Sproul Rd Ste 207

1/14

Springfield, PA 19064-2045 · Phone (610) 872-8501 · Fax (610) 872-5188

501 S 54th St Ste 227

2/14

Philadelphia, PA 19143-1900 · Phone (610) 872-8501 · Fax (610) 872-5188

1001 Baltimore Pike Ste 109

3/14

Springfield, PA 19064-2852 · Phone (610) 872-8501 · Fax (610) 872-5188

1088 W Baltimore Pike Ste 2105

4/14

Media, PA 19063-5136 · Phone (610) 872-8501 · Fax (610) 872-5188

1501 Lansdowne Ave Ste 201

5/14

Darby, PA 19023-1333 · Phone (610) 872-8501 · Fax (610) 872-5188

520 Maple Ave Ste 3

6/14

West Chester, PA 19380-4434 · Phone (610) 872-8501 · Fax (610) 872-5188

1020 Baltimore Pike Ste 220

7/14

Glen Mills, PA 19342-1372 · Phone (610) 872-8501 · Fax (610) 872-5188

1098 W Baltimore Pike Ste 3306

8/14

Media, PA 19063 · Phone (610) 872-8501 · Fax (610) 872-5188

300 Evergreen Dr Ste 130

9/14

Glen Mills, PA 19342-1081 · Phone (610) 872-8501 · Fax (610) 872-5188

8 Morton Ave Ste 304

10/14

Ridley Park, PA 19078-2216 · Phone (610) 872-8501 · Fax (610) 872-5188

213 Reeceville Rd Ste 37

11/14

Coatesville, PA 19320-1533 · Phone (610) 872-8501 · Fax (610) 872-5188

1015 W Baltimore Pike Ste 310

12/14

West Grove, PA 19390-9459 · Phone (610) 872-8501 · Fax (610) 872-5188

255 W Lancaster Ave Ste 200

13/14

Paoli, PA 19301-1763 · Phone (610) 872-8501 · Fax (610) 872-5188

860 Springdale Dr Ste 100

14/14

Exton, PA 19341-2834 · Phone (610) 872-8501 · Fax (610) 872-5188

Other Provider Identifiers 6

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

0032975000 Other

1/6

State: PA · Issuer: Personal Choice
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

CF3534 Other

2/6

State: PA · Issuer: Rail Road Medicare
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

0032975000 Other

3/6

State: PA · Issuer: Amerihealth
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

045319 Other

4/6

State: PA · Issuer: Keystone Mercy
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

000760867-0013 Medicaid

5/6

State: PA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

110372 Other

6/6

State: PA · Issuer: Bcbs Pa
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

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