Active NPI
Pamela Denise Keenan, AUDIOLOGIST MA.,CCCA
- Audiologist
- Kentwood, MI
National Provider Identifier
1003847567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 1601000146
- Practice address
- 4444 Kalamazoo Ave SE
Kentwood, MI 49508-4600 - Phone
- (616) 455-9180
- Fax
- (616) 574-0215
- NPI assigned
- Jul 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000146 | MI | Primary |
Addresses
Primary practice location
4444 Kalamazoo Ave SE
Kentwood, MI 49508-4600
Mailing address
961 4 Mile Rd NW
Grand Rapids, MI 49544-8252
Phone (616) 455-9180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804784633 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Qualified Audiologist
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
961 4 Mile Rd NW
Suite a
Grand Rapids, MI 49544-8252
Phone (616) 784-6299
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601000146 | MI | MD | Audiologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba McDonald Audiology & Hearing Health Care
- Hearing Instrument Specialist
- Grand Rapids, MI
- NPI 1245277839
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464134400000",
"number": "1003847567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "961 4 MILE RD NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495448252",
"telephone_number": "616-455-9180",
"fax_number": "616-574-0215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 KALAMAZOO AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495084600",
"telephone_number": "616-455-9180",
"fax_number": "616-574-0215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEENAN",
"first_name": "PAMELA",
"middle_name": "DENISE",
"name_prefix": "Mrs.",
"credential": "AUDIOLOGIST MA.,CCCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-05",
"last_updated": "2016-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MI",
"license": "1601000146",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "804784633",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.