Individual provider Active NPI

Katherine Ann Keith, M.D.

  • Internal Medicine Physician
  • Berrien Springs, MI
National Provider Identifier
1104806116
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301081055 Issued in MI
Practice address
9045 US Highway 31
Berrien Springs, MI 49103-1804
Phone
(269) 473-2222
Fax
(269) 473-6880
NPI assigned
Jan 18, 2006
Last updated
Nov 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301081055 MI Primary
Pediatrics Physician 208000000X 4301081055 MI

Addresses

Primary practice location

9045 US Highway 31
Berrien Springs, MI 49103-1804

Mailing address

9045 US Highway 31
Berrien Springs, MI 49103-1804
Phone (269) 473-2222

Other identifiers 4

IdentifierTypeStateIssuer
1902086689OtherMIGROUP NPI
P17270001OtherMIMEDICARE INDIVIDUAL PTAN
104694670MedicaidMI
700A146860OtherMIBCBSM GROUP PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20050131001022 MI Practitioner - Internal Medicine 0345290987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

9045 US Hwy 31
Suite 3
Berrien Springs, MI 49103-1804
Phone (269) 471-9702

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301081055MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices Internal Medicine CurrentSince Dec 1, 2019 Accepting new patients
Lakeland Medical Practices Internal Medicine CurrentSince Dec 1, 2019 Accepting new patients
Ambulatory United Past Accepting new patients

Locations

9045 US Highway 31
Berrien Springs, MI 49103
Phone (269) 473-2222

9045 US Highway 31
Ste 3
Berrien Springs, MI 49103
Phone (269) 471-9702

9045 US Highway 31
Ste A
Berrien Springs, MI 49103
Phone (269) 473-2222

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

Interoperability endpoints

  • Direct secure messaging: kkeith12215@lakeland.midirect.net
  • Direct secure messaging: kkeith1270239@epic00.corewelldirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1104806116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-473-2222",
            "fax_number": "269-473-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301081055",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301081055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1902086689",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "P17270001",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104694670",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP PIN",
            "identifier": "700A146860",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berrien Springs, MI

Sources for this page

Verify at the official NPI Registry.