NPIMap

Individual provider Active NPI

Keith Lewis Fabrique, MD

  • Occupational Medicine Physician
  • Decatur, IL
National Provider Identifier
1225196710
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
036050458 Issued in IL
Practice address
1750 E Lake Shore Dr
Lower Level
Decatur, IL 62521
Phone
(217) 425-2732
Fax
(217) 425-4778
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036050458 IL
Occupational Medicine Physician 2083X0100X 036050458 IL Primary

Addresses

Primary practice location

1750 E Lake Shore Dr
Lower Level
Decatur, IL 62521

Mailing address

1750 E Lake Shore Dr
Lower Level
Decatur, IL 62521
Phone (217) 425-2732

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kfabrique167974@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036050458ILMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Back to Health Clinic SC Past Accepting new patients
Sangamon County Pain Center Past Accepting new patients
Clarion Healing Center, LTD Family Medicine Past Accepting new patients
HSHS Medical Group Inc PastSince Mar 24, 2025 Accepting new patients
Walsh Chiropractic LTD Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kfabrique167974@ewd.direct.hshs.org

Organizations & group practices 5

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": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1225196710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "address_2": "LOWER LEVEL",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62521",
            "telephone_number": "217-425-2732",
            "fax_number": "217-425-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "address_2": "LOWER LEVEL",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62521",
            "telephone_number": "217-425-2732",
            "fax_number": "217-425-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABRIQUE",
        "first_name": "KEITH",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036050458",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": "036050458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfabrique167974@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1750 E Lake Shore Dr",
            "address_2": "Lower Level",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.