Active NPI
Mark Ndugo Keigi, MD
- General Practice Physician
- Bear, DE
National Provider Identifier
1043841620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2019034785
- Practice address
- 2821 Squirrel Dr
Bear, DE 19701-2765 - Phone
- (786) 328-9209
- NPI assigned
- Jan 31, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 2019034785 | MO | Primary |
Addresses
Primary practice location
2821 Squirrel Dr
Bear, DE 19701-2765
Mailing address
2821 Squirrel Dr
Bear, DE 19701-2765
Phone (786) 328-9209
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2019304785 | Other | MO | ASSISTANT PHYSICIAN LICENSE |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019034785 | MO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1043841620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2821 SQUIRREL DR",
"city": "BEAR",
"state": "DE",
"postal_code": "197012765",
"telephone_number": "786-328-9209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2821 SQUIRREL DR",
"city": "BEAR",
"state": "DE",
"postal_code": "197012765",
"telephone_number": "786-328-9209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEIGI",
"first_name": "MARK",
"middle_name": "NDUGO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-31",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "2019034785",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASSISTANT PHYSICIAN LICENSE",
"identifier": "2019304785",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bear, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.