William Stewart Ketcham, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

29605 Issued in NC

Practice address

501 Health Park Dr
Ste 150
Garner, NC 27529-7051

Phone

(919) 772-3487

Fax

(919) 772-3446

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

West Virginia University School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Dermatology PAGroup PAC ID 7012971609, 52 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wketcham@aadermaffiliates.emadirect.md

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.

• Southern Dermatology, P.a.

  • Specialist
  • Raleigh, NC
  • NPI 1568415586
  Medicare reassignment Care Compare group NPD
• Anne Arundel Dermatology Affiliates PC

  • Dermatology Physician
  • Hunt Valley, MD
  • NPI 1083200794
  NPD (past)

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1093866006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 HEALTH PARK DR",
            "address_2": "STE 150",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275297051",
            "telephone_number": "919-772-3487",
            "fax_number": "919-772-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 HEALTH PARK DR",
            "address_2": "STE 150",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275297051",
            "telephone_number": "919-772-3487",
            "fax_number": "919-772-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHAM",
        "first_name": "WILLIAM",
        "middle_name": "STEWART",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "29605",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "29605",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "29605",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "070014474",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "30499",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4510902",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3330875-004",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "95508",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0273L",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IND",
            "identifier": "48795",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "562147357",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "290649",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Horne Keene, N. P.
• Keith Fetterolf, DMD, P.a.
• Lisa Kelbaugh, LPCA
• Kristina Keltner, FNP
• Katie L Kepner, P.T.
• Kevin Arthur DDS PA
• Fredrick L Keyser III, DDS PA
• Faisal Mahmood Khan, MD, MBBS
• Kaleb Kibbs
• Mikala Kilpatrick

• MOHS-Micrographic Surgery Physician in Garner, NC
• Providers in Garner, NC by specialty
• MOHS-Micrographic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.
• 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.