NPIMap

Individual provider Active NPI

Dustin Thomas Keenan, PA-S

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1124683420
Registry record updated Aug 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3510 Issued in SC
Practice address
14 Richland Medical Park Dr Ste 200
Columbia, SC 29203-6882
Phone
(803) 296-7846
Fax
(803) 296-9699
NPI assigned
May 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2026

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 3510 SC Primary

Addresses

Primary practice location

14 Richland Medical Park Dr Ste 200
Columbia, SC 29203-6882

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 695-6697

Other practice location 1

300 East Hosptial Road
Fort Gordon, GA 30905
Phone (864) 491-8450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200325002702 SC Practitioner - Physician Assistant 1557799525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

104 Saluda Pointe Dr
Lexington, SC 29072-7295
Phone (803) 296-7846

14 Richland Medical Park Dr
Suite 200
Columbia, SC 29203-6882
Phone (803) 296-7846

300 Palmetto Health Pkwy
Columbia, SC 29212-1762

Hospital & facility affiliations

  • Prisma Health Homecare Home health agency, Columbia, SC, CCN 427013
  • Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018
  • Prisma Health Baptist Hospital, Columbia, SC, CCN 420086
  • Prisma Health Baptist Parkridge Hospital, Columbia, SC, CCN 420106
  • Prisma Health Tuomey Hospital Hospital, Sumter, SC, CCN 420070

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Mar 9, 2020 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Mar 9, 2020 Accepting new patients
Prisma Health Medical Group-Midlands Past Accepting new patients

Locations

101 Business Park Blvd
#2
Columbia, SC 29203

14 Richland Medical Park Dr
Ste 200
Columbia, SC 29203
Phone (803) 296-9200

101 Business Park Blvd
Fl 2
Columbia, SC 29203
Phone (803) 296-9200

100 Palmetto Health Pkwy
Ste 250
Columbia, SC 29212
Phone (803) 407-3857

1120 Roberts Branch Pkwy
#200
Columbia, SC 29203

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Interoperability endpoints

  • Direct secure messaging: dkeenan381321@direct.ghs.myhfn.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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787961600000",
    "number": "1124683420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-695-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RICHLAND MEDICAL PARK DR STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036882",
            "telephone_number": "803-296-7846",
            "fax_number": "803-296-9699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 East Hosptial Road",
            "address_purpose": "LOCATION",
            "city": "Fort Gordon",
            "state": "GA",
            "postal_code": "30905",
            "country_code": "US",
            "telephone_number": "864-491-8450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "DUSTIN",
        "middle_name": "THOMAS",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-02",
        "last_updated": "2026-08-29",
        "certification_date": "2026-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.