Individual provider Active NPI

Jessica Keep

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1063196277
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704330668 Issued in MI
Practice address
22101 Moross Rd
Detroit, MI 48236-2148
Phone
(313) 343-4000
NPI assigned
Jun 9, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704330668 MI Primary
Registered Nurse 163W00000X 4704330668 MI

Addresses

Primary practice location

22101 Moross Rd
Detroit, MI 48236-2148

Mailing address

1890 Lakeville Rd
Leonard, MI 48367-3305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231011000981 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 4789039751 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Long Lake Anesthesiology Consultants PLCGroup PAC ID 7113818980, 94 clinicians

Practice addresses (Care Compare)

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-4000

4550 Investment Dr
Troy, MI 48098-6334
Phone (248) 265-4600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Long Lake Anesthesiology Consultants, PLC CurrentSince Jun 1, 2025 Accepting new patients
Henry Ford Health St. John Hospital Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2023 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Oct 1, 2023 Accepting new patients

Locations

2009 Momentum Pl
Chicago, IL 60689

7915 Solutions Ctr Dr
Chicago, IL 60677

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

920 River Centre Dr
Port Huron, MI 48060
Phone (810) 984-5200

4550 Investment Dr
Ste 100
Troy, MI 48098
Phone (248) 265-4600

Organizations & group practices 4

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 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": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1063196277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LAKEVILLE RD",
            "city": "LEONARD",
            "state": "MI",
            "postal_code": "483673305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEP",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-10-05",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704330668",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704330668",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.

Verify at the official NPI Registry.