Individual provider Active NPI

Ranita R Keller, FNP

  • Family Nurse Practitioner
  • Edwardsville, IL
National Provider Identifier
1083096895
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277000539 Issued in IL
Practice address
2122 Troy Rd Ste 130
Edwardsville, IL 62025-2540
Phone
(618) 800-4500
NPI assigned
Jun 29, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 277000539 IL Primary
Nurse Practitioner 363L00000X 2015032216 MO

Addresses

Primary practice location

2122 Troy Rd Ste 130
Edwardsville, IL 62025-2540

Mailing address

2122 Troy Rd Ste 130
Edwardsville, IL 62025-2540
Phone (618) 800-4500

Other practice location 1

2 Cottonwood Rd
Glen Carbon, IL 62034-2782
Phone (314) 687-2663

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address rkeller181848@direct-ehr-ssmhc.com Direct
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702000564 IL Practitioner - Nurse Practitioner 5890007900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

2122 Troy Rd
Suite 130
Edwardsville, IL 62025-2540
Phone (618) 463-7600

5213 Godfrey Rd
Suite 110
Godfrey, IL 62035-2510
Phone (618) 619-3330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Jun 1, 2021 Accepting new patients
Fairview Heights Medical Group SC Current Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

163 E Bethalto Dr
Bethalto, IL 62010
Phone (618) 433-6490

2122 Troy Rd
Edwardsville, IL 62025
Phone (618) 655-0386

2122 Troy Rd
#130
Edwardsville, IL 62025

2122 Troy Rd
Ste 130
Edwardsville, IL 62025
Phone (618) 692-9876

5213 Godfrey Rd
Ste 110
Godfrey, IL 62035
Phone (618) 619-3330

4000 N Illinois Ln
Swansea, IL 62226
Phone (618) 233-8130

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

Interoperability endpoints

  • Direct secure messaging: rkeller181848@direct-ehr-ssmhc.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1083096895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 TROY RD STE 130",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252540",
            "telephone_number": "618-800-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 TROY RD STE 130",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252540",
            "telephone_number": "618-800-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Cottonwood Rd",
            "address_purpose": "LOCATION",
            "city": "Glen Carbon",
            "state": "IL",
            "postal_code": "620342782",
            "country_code": "US",
            "telephone_number": "314-687-2663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "RANITA",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000539",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2015032216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Cottonwood Rd",
            "city": "Glen Carbon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620342782",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkeller181848@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rkeller181848@direct-ehr-ssmhc.com",
            "address_1": "2 Cottonwood Rd",
            "city": "Glen Carbon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620342782",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2122 Troy Rd Ste 130",
            "city": "Edwardsville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620252540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.