Individual provider Active NPI

Modibo Keita

  • Certified Registered Nurse Anesthetist
  • Fort Worth, TX
National Provider Identifier
1205729928
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
885241 Issued in TX
Practice address
8908 Preakness Cir
Fort Worth, TX 76123-3582
Phone
(352) 870-7404
NPI assigned
Jun 2, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 885241 TX Primary

Addresses

Primary practice location

8908 Preakness Cir
Fort Worth, TX 76123-3582

Mailing address

8908 Preakness Cir
Fort Worth, TX 76123-3582
Phone (352) 870-7404

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251022002522 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214425156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
U S Anesthesia Partners of Texas, PAGroup PAC ID 7315850351, 2,750 clinicians

Practice addresses (Care Compare)

1635 N Loop W
Greater Houston Anesthesiology
Houston, TX 77008-1532
Phone (713) 867-3300

Hospital & facility affiliations

  • Memorial Hermann - Texas Medical Center Hospital, Houston, TX, CCN 450068
  • Memorial Hermann Katy Hospital Hospital, Katy, TX, CCN 450847

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
885241TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
U. S. Anesthesia Partners of Texas, P.a., Nurse Anesthetist, Certified Registered CurrentSince Oct 10, 2025 Accepting new patients
U S Anesthesia Partners of Texas, PA Nurse Anesthetist, Certified Registered CurrentSince Oct 10, 2025 Accepting new patients

Locations

7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000

1635 North Loop W
Houston, TX 77008
Phone (713) 867-2066

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

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 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": "1748822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1205729928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8908 PREAKNESS CIR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233582",
            "telephone_number": "352-870-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8908 PREAKNESS CIR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233582",
            "telephone_number": "352-870-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITA",
        "first_name": "MODIBO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-02",
        "last_updated": "2025-06-02",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "885241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.