Individual provider Active NPI

Deborah Ann Keck, M.S., CCC-A

  • Audiologist
  • Roseville, CA
National Provider Identifier
1215359534
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU1094 Issued in CA
Practice address
3 Medical Plaza Dr Ste 220
Roseville, CA 95661-3088
Phone
(916) 773-7920
Fax
(916) 773-7919
NPI assigned
Jan 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU1094 CA Primary

Addresses

Primary practice location

3 Medical Plaza Dr Ste 220
Roseville, CA 95661-3088

Mailing address

999 S Fairmont Ave
Suite 215
Lodi, CA 95240-5100
Phone (209) 333-8510

Other identifiers 2

IdentifierTypeStateIssuer
AU1094MedicaidCA
AU1094OtherCASTATE LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address planchdk@suterhealth.org
Direct Messaging Address planchdk@sutterhealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150506001511 CA Practitioner - Qualified Audiologist 9830418201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2800 L St
Sacramento, CA 95816-5616

3 Medical Plaza Dr
Roseville, CA 95661-3088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
AU1094CAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Feb 3, 2020 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

3 Medical Plaza Dr
Ste 220
Roseville, CA 95661
Phone (916) 773-7920

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1215359534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "SUITE 215",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405100",
            "telephone_number": "209-333-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PLAZA DR STE 220",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613088",
            "telephone_number": "916-773-7920",
            "fax_number": "916-773-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KECK",
        "first_name": "DEBORAH",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "M.S., CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-07",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU1094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AU1094",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AU1094",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "planchdk@suterhealth.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "3 Medical Plaza Dr Ste 220",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "planchdk@sutterhealth.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "3 Medical Plaza Dr Ste 220",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.