Active NPI
Jack C. Keen, M.D.
- Specialist
- Cresson, TX
National Provider Identifier
1063759652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G4144
- Practice address
- 408 Stone Mountain CT
Cresson, TX 76035-5628 - Phone
- (817) 512-3006
- NPI assigned
- Jan 15, 2013
- Last updated
- Jan 15, 2013
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G4144 | TX | Primary |
Addresses
Primary practice location
408 Stone Mountain CT
Cresson, TX 76035-5628
Mailing address
408 Stone Mountain CT
Cresson, TX 76035-5628
Phone (817) 512-3006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358208000000",
"number": "1063759652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 STONE MOUNTAIN CT",
"city": "CRESSON",
"state": "TX",
"postal_code": "760355628",
"telephone_number": "817-512-3006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 STONE MOUNTAIN CT",
"city": "CRESSON",
"state": "TX",
"postal_code": "760355628",
"telephone_number": "817-512-3006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEEN",
"first_name": "JACK",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-15",
"last_updated": "2013-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "G4144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cresson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.