Active NPI
Scott Robert Keller, M.D.
- Pediatrics Physician
- Swansea, IL
National Provider Identifier
1003942145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036.132786
- Practice address
- 3 Park PL
Swansea, IL 62226-2965 - Phone
- (618) 222-9244
- Fax
- (618) 222-9248
- NPI assigned
- Feb 25, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2007011139 | MO | |
| Pediatrics Physician | 208000000X | 2004014306 | MO | |
| Pediatrics Physician | 208000000X | 036.132786 | IL | Primary |
Addresses
Primary practice location
3 Park PL
Swansea, IL 62226-2965
Mailing address
3 Park PL
Swansea, IL 62226-2965
Phone (618) 222-9244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209903004 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.132786 | IL | MD | Pediatrics Physician |
| 2004014306 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Health Care St. Louis | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- skeller24670@direct-ehr-ssmhc.com
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380672000000",
"number": "1003942145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 PARK PL",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262965",
"telephone_number": "618-222-9244",
"fax_number": "618-222-9248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 PARK PL",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262965",
"telephone_number": "618-222-9244",
"fax_number": "618-222-9248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "SCOTT",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-25",
"last_updated": "2013-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2007011139",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2004014306",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036.132786",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209903004",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.