NPIMap

Individual provider Active NPI

Keith Douglas Horner, MD

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1235103334
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H4421 Issued in TX
Practice address
342 Richland West Cir
Waco, TX 76712-7919
Phone
(254) 537-0200
Fax
(254) 537-0201
NPI assigned
Feb 15, 2006
Last updated
Jan 20, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H4421 TX Primary

Addresses

Primary practice location

342 Richland West Cir
Waco, TX 76712-7919

Mailing address

PO Box 22010
Waco, TX 76702-2010
Phone (254) 761-8811

Other identifiers 3

IdentifierTypeStateIssuer
00N59XOtherBCBS TEXAS
128110705MedicaidTX
88X541OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100208000260 TX Practitioner - Family Practice 0648328039 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

301 Richland W Cir
Providence Internal Medicine Clinic
Waco, TX 76712-7932
Phone (254) 537-6200

340 Richland W Cir
Ascension Medical Group Providence
Waco, TX 76712-7919
Phone (254) 537-6050

342 Richland W Cir
Waco, TX 76712-7919
Phone (254) 537-6600

5400 Laurel Lake Dr
Waco, TX 76710-2835
Phone (254) 399-6633

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health Alliance CurrentSince Oct 1, 2010 Accepting new patients
Providence Health Alliance CurrentSince Oct 1, 2010 Accepting new patients

Locations

301 Richland West Cir
Waco, TX 76712
Phone (254) 537-6200

342 Richland West Cir
Waco, TX 76712
Phone (254) 537-0200

6901 Medical Pkwy
Waco, TX 76712
Phone (254) 751-4000

Interoperability endpoints

  • Direct secure messaging: keith.horner.1@9635.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1235103334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22010",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767022010",
            "telephone_number": "254-761-8811",
            "fax_number": "254-761-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 RICHLAND WEST CIR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127919",
            "telephone_number": "254-537-0200",
            "fax_number": "254-537-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORNER",
        "first_name": "KEITH",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H4421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TEXAS",
            "identifier": "00N59X",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128110705",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88X541",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.