Active NPI
Jason Keating
- Addiction (Substance Use Disorder) Counselor
- Fairborn, OH
National Provider Identifier
1093185100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 121035
- Practice address
- 1082 Whitetail Dr
Fairborn, OH 45324-8718 - Phone
- (614) 787-3247
- NPI assigned
- Oct 1, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 121035 | OH | Primary |
| Clinical Social Worker | 1041C0700X | 121035 | OH |
Addresses
Primary practice location
1082 Whitetail Dr
Fairborn, OH 45324-8718
Mailing address
1082 Whitetail Dr
Fairborn, OH 45324-8718
Phone (614) 787-3247
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351928552 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121035 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1093185100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1082 WHITETAIL DR",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453248718",
"telephone_number": "614-787-3247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1082 WHITETAIL DR",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453248718",
"telephone_number": "614-787-3247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEATING",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-01",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "121035",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "121035",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "351928552",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.