Active NPI
Richard Allan Keresey, PAC
- Physician Assistant
- Indianapolis, IN
National Provider Identifier
1114093390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10000012A
- Practice address
- 5603 W Raymond
Suite a
Indianapolis, IN 46241-4356 - Phone
- (317) 241-8266
- Fax
- (317) 247-4978
- NPI assigned
- Nov 28, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10000012A | IN | Primary |
Addresses
Primary practice location
5603 W Raymond
Suite a
Indianapolis, IN 46241-4356
Mailing address
4850 W Century Plaza Rd
Indianapolis, IN 46254
Phone (317) 216-2828
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 |
|---|---|---|---|
| 10000012A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| U.S. Healthworks | Past | Accepting new patients |
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.
-
- Occupational Medicine Clinic/Center
- Indianapolis, IN
- NPI 1942635214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114093390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4850 W CENTURY PLAZA RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46254",
"telephone_number": "317-216-2828",
"fax_number": "317-216-2839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5603 W RAYMOND",
"address_2": "SUITE A",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462414356",
"telephone_number": "317-241-8266",
"fax_number": "317-247-4978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERESEY",
"first_name": "RICHARD",
"middle_name": "ALLAN",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10000012A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.