Individual provider Active NPI

Keaton James Fletcher, DO

  • Family Medicine Physician
  • Grants Pass, OR
National Provider Identifier
1053042408
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO226364 Issued in OR
Practice address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone
(541) 472-4777
Fax
(541) 471-1439
NPI assigned
Jun 17, 2022
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0542R OK
Family Medicine Physician 207Q00000X DO226364 OR Primary

Addresses

Primary practice location

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Mailing address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777

Other practice location 1

25647 Redwood Hwy
Cave Junction, OR 97523-9332
Phone (541) 592-4111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20251016004391 OR Practitioner - Family Practice 7618464157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0542ROKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siskiyou Community Health Center, Inc CurrentSince Sep 29, 2025 Accepting new patients
Siskiyou Community Health Center, Inc. CurrentSince Sep 29, 2025 Accepting new patients

Locations

1701 NW Hawthorne Ave
Grants Pass, OR 97526
Phone (541) 471-3455

1701 NW Hawthorne Ave
#201
Grants Pass, OR 97526

Interoperability endpoints

  • Direct secure messaging: keaton.fletcher.p1@direct.siskiyou.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1053042408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-1439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25647 Redwood Hwy",
            "address_purpose": "LOCATION",
            "city": "Cave Junction",
            "state": "OR",
            "postal_code": "975239332",
            "country_code": "US",
            "telephone_number": "541-592-4111",
            "fax_number": "541-592-3916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "KEATON",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-17",
        "last_updated": "2025-08-07",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "0542R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO226364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

Verify at the official NPI Registry.