Individual provider Active NPI

Douglas Scott Keith, M.D.

  • Nephrology Physician
  • Pensacola, FL
National Provider Identifier
1023290475
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME128786 Issued in FL
Practice address
5149 N 9TH Ave
Pensacola, FL 32504-8756
Phone
(850) 416-1080
Fax
(850) 416-1089
NPI assigned
Nov 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME128786 FL Primary

Addresses

Primary practice location

5149 N 9TH Ave
Pensacola, FL 32504-8756

Mailing address

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6014

Other practice location 1

4583 Watkins St
Pace, FL 32571-2511
Phone (850) 889-4152

Other practice location 2

8880 Navarre Pkwy Ste 101
Navarre, FL 32566-3613
Phone (850) 862-2385

Other practice location 3

4304 Lancaster Dr
Niceville, FL 32578-4563
Phone (850) 862-2385

Other practice location 4

5934 Berryhill Medical Park Dr # 1
Milton, FL 32570
Phone (850) 623-4771

Other practice location 5

14114 Alabama St
Jay, FL 32565-1219
Phone (850) 444-4700

Other practice location 6

1118 Gulf Breeze Pkwy Ste 200
Gulf Breeze, FL 32561-7806
Phone (850) 444-4700

Other practice location 7

319 Green Acres Rd Ste 103
Fort Walton Beach, FL 32547-1170
Phone (850) 862-2385

Other practice location 8

2940 N Blue Angel Pkwy
Pensacola, FL 32506-2925
Phone (850) 444-4700

Other practice location 9

1717 N E St Ste 403
Pensacola, FL 32501-6334
Phone (850) 444-4700

Other practice location 10

6001 Industrial Blvd
Century, FL 32535-3312
Phone (850) 444-4700

Other practice location 11

221 E Redstone Ave
Crestview, FL 32539-5373
Phone (850) 398-6606

Other practice location 12

4415 US Highway 331 S
Defuniak Springs, FL 32435-6307
Phone (850) 398-6606

Other practice location 13

36474A Emerald Coast Pkwy Ste 1102
Destin, FL 32541-3706
Phone (850) 862-2385

Other practice location 14

1619 Creighton Rd Ste 1
Pensacola, FL 32504-7152
Phone (850) 444-4700

Other identifiers 3

IdentifierTypeStateIssuer
017974800MedicaidFL
ME128786OtherFLFLORIDA MEDICAL LICENSURE
P01853620OtherFLFLORIDA RR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160913000267 FL Practitioner - NephrologyPractitioner - Internal Medicine 2567542343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Mayo Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sacred Heart Health System IncGroup PAC ID 3779491386, 373 clinicians

Practice addresses (Care Compare)

5149 N 9TH Ave
Suite 246
Pensacola, FL 32504-8755
Phone (850) 416-1080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME128786FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health System, Inc. CurrentSince Oct 21, 2019 Accepting new patients
Sacred Heart Health System Inc CurrentSince Oct 21, 2019 Accepting new patients
Renal Care Group of the Southeast, Inc. Past Accepting new patients
Modern Chiropractic of Florida PastSince Feb 16, 2022 Accepting new patients
Sacred Heart Health System, Inc. Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

4501 N Davis Hwy
Ste A
Pensacola, FL 32503
Phone (850) 476-9000

5149 N 9th Ave
Ste 246
Pensacola, FL 32504
Phone (850) 416-1080

Interoperability endpoints

  • Direct secure messaging: douglas.keith.1@9582.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1023290475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6014",
            "fax_number": "904-450-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5149 N 9TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048756",
            "telephone_number": "850-416-1080",
            "fax_number": "850-416-1089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4583 Watkins St",
            "address_purpose": "LOCATION",
            "city": "Pace",
            "state": "FL",
            "postal_code": "325712511",
            "country_code": "US",
            "telephone_number": "850-889-4152",
            "fax_number": "850-623-3938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8880 Navarre Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Navarre",
            "state": "FL",
            "postal_code": "325663613",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4304 Lancaster Dr",
            "address_purpose": "LOCATION",
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            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5934 Berryhill Medical Park Dr # 1",
            "address_purpose": "LOCATION",
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            "state": "FL",
            "postal_code": "32570",
            "country_code": "US",
            "telephone_number": "850-623-4771",
            "fax_number": "850-623-3938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14114 Alabama St",
            "address_purpose": "LOCATION",
            "city": "Jay",
            "state": "FL",
            "postal_code": "325651219",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1118 Gulf Breeze Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325617806",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "319 Green Acres Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325471170",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 N Blue Angel Pkwy",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325062925",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1717 N E St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325016334",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6001 Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Century",
            "state": "FL",
            "postal_code": "325353312",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 E Redstone Ave",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395373",
            "country_code": "US",
            "telephone_number": "850-398-6606",
            "fax_number": "850-398-6424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4415 US Highway 331 S",
            "address_purpose": "LOCATION",
            "city": "Defuniak Springs",
            "state": "FL",
            "postal_code": "324356307",
            "country_code": "US",
            "telephone_number": "850-398-6606",
            "fax_number": "850-398-6424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36474A Emerald Coast Pkwy Ste 1102",
            "address_purpose": "LOCATION",
            "city": "Destin",
            "state": "FL",
            "postal_code": "325413706",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1619 Creighton Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325047152",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEITH",
        "first_name": "DOUGLAS",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME128786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017974800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAL LICENSURE",
            "identifier": "ME128786",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA RR MEDICARE",
            "identifier": "P01853620",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.