Individual provider Active NPI

Margaret Mary Keane, M.D.

  • Pediatrics Physician
  • Shreveport, LA
National Provider Identifier
1063770949
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
64342-20 Issued in WI
Practice address
2508 Bert Kouns Industrial Loop Ste 320
Shreveport, LA 71118-3167
Phone
(318) 212-5990
Fax
(318) 212-5887
NPI assigned
Apr 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 64342-20 WI Primary

Addresses

Primary practice location

2508 Bert Kouns Industrial Loop Ste 320
Shreveport, LA 71118-3167

Mailing address

Willis Knighton Physician Network
1202 Louisiana Avenue
Shreveport, LA 71101-3910
Phone (318) 212-8951

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181101000200 LA Practitioner - Hospitalist 3678826021 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64342-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
WK South Hospitalists CurrentSince Sep 25, 2018 Accepting new patients
Willis Knighton Medical Center, Inc. Past Accepting new patients

Locations

2508 Bert Kouns Industrial Loop
Ste 320
Shreveport, LA 71118
Phone (318) 212-5990

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

2508 Bert Kouns Industrial Loop
Shreveport, LA 71118
Phone (318) 212-5880

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1063770949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WILLIS KNIGHTON PHYSICIAN NETWORK",
            "address_2": "1202 LOUISIANA AVENUE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-8951",
            "fax_number": "318-212-6752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 320",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183167",
            "telephone_number": "318-212-5990",
            "fax_number": "318-212-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEANE",
        "first_name": "MARGARET",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "64342-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.