Individual provider Active NPI

Timothy Ryan Keegan, DO

  • Student in an Organized Health Care Education/Training Program
  • Chapel Hill, NC
National Provider Identifier
1184129447
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
2023-02945 Issued in NC
Practice address
101 Manning Dr RM 1017
Chapel Hill, NC 27514-4226
Phone
(984) 974-1072
NPI assigned
Mar 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 678694 TX
Student in an Organized Health Care Education/Training Program 390200000X 2023-02945 NC Primary

Addresses

Primary practice location

101 Manning Dr RM 1017
Chapel Hill, NC 27514-4226

Mailing address

5513 Virgin Rock Rd
Centreville, VA 20120-3311
Phone (703) 967-9924

Other practice location 1

1 Baylor Plz # Bcm320
Houston, TX 77030-3411
Phone (800) 663-9664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210701000783 NC Order and Referring Only - AnesthesiologyPractitioner - Anesthesiology 2961803697

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
678694TXMDFamily Nurse Practitioner
2023-02945NCMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1184129447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5513 VIRGIN ROCK RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201203311",
            "telephone_number": "703-967-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MANNING DR RM 1017",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275144226",
            "telephone_number": "984-974-1072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz # Bcm320",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "800-663-9664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEEGAN",
        "first_name": "TIMOTHY",
        "middle_name": "RYAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "678694",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "2023-02945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.