Individual provider Active NPI

Joseph Wade Keller, PA-C

  • Medical Physician Assistant
  • Vero Beach, FL
National Provider Identifier
1144520958
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
50.003164 Issued in OH
Practice address
1000 36TH St
Vero Beach, FL 32960-4862
Phone
(216) 408-6532
NPI assigned
Oct 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 50.003164 OH Primary

Addresses

Primary practice location

1000 36TH St
Vero Beach, FL 32960-4862

Mailing address

3450 11TH CT FL 3
Vero Beach, FL 32960-5012
Phone (216) 408-6532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101112000006 OH Practitioner - Physician Assistant 6507051893
I20241212004208 FL Practitioner - Physician Assistant 6507051893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indian River Health Services IncGroup PAC ID 9234130329, 335 clinicians

Practice addresses (Care Compare)

1000 36TH St
Vero Beach, FL 32960-4862
Phone (772) 567-4311

1190 37TH St
Vero Beach, FL 32960-6507
Phone (772) 567-4311

Hospital & facility affiliations

  • Cleveland Clinic Indian River Hospital Hospital, Vero Beach, FL, CCN 100105

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003164OHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Indian River Health Services Inc CurrentSince Jan 1, 2025 Accepting new patients
Indian River Health Services Inc CurrentSince Jan 1, 2025 Accepting new patients

Locations

1190 37th St
Vero Beach, FL 32960
Phone (772) 563-4666

1000 36th St
Vero Beach, FL 32960
Phone (772) 567-1942

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

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 1

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": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1144520958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 11TH CT FL 3",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605012",
            "telephone_number": "216-408-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 36TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "216-408-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JOSEPH",
        "middle_name": "WADE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-26",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.003164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

Verify at the official NPI Registry.