Individual provider Active NPI

Keith William Bell, PA

  • Physician Assistant
  • Bend, OR
National Provider Identifier
1104139369
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA150075 Issued in OR
Practice address
2084 NE Professional CT
Bend, OR 97701-6077
Phone
(541) 383-3005
Fax
(541) 383-1883
NPI assigned
Jul 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA150075 OR Primary

Addresses

Primary practice location

2084 NE Professional CT
Bend, OR 97701-6077

Mailing address

600 SW Columbia St
Suite 6210
Bend, OR 97702-1099
Phone (541) 383-3005

Other identifiers 1

IdentifierTypeStateIssuer
500641592MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20130425000138 OR Practitioner - Physician Assistant 9133365810 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA150075ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaic Community Health CurrentSince Mar 16, 2013 Accepting new patients

Locations

600 SW Columbia St
Ste 6210
Bend, OR 97702

2084 NE Professional Ct
Bend, OR 97701
Phone (541) 322-5753

375 NW Beaver St
Ste 101
Prineville, OR 97754
Phone (541) 316-6026

Interoperability endpoints

  • Direct secure messaging: keith.bell@cfim-or.direct.office.nextgen.com

Organizations & group practices 1

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": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1104139369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SW COLUMBIA ST",
            "address_2": "SUITE 6210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021099",
            "telephone_number": "541-383-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 NE PROFESSIONAL CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016077",
            "telephone_number": "541-383-3005",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELL",
        "first_name": "KEITH",
        "middle_name": "WILLIAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA150075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641592",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.