Active NPI
Mitchell S Keil, PSYD
- Psychologist
- Newport Beach, CA
National Provider Identifier
1235647280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY29644
- Practice address
- 3300 Irvine Ave Ste 111
Newport Beach, CA 92660-3115 - Phone
- (714) 334-5497
- NPI assigned
- Jan 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY29644 | CA | Primary |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Family Psychologist | 103TF0000X | |||
| Group Psychotherapy Psychologist | 103TP2701X |
Addresses
Primary practice location
3300 Irvine Ave Ste 111
Newport Beach, CA 92660-3115
Mailing address
3300 Irvine Ave Ste 111
Newport Beach, CA 92660-3115
Phone (714) 334-5497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 20, 2022 through Oct 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29644 | CA | MD | Mental Health Counselor |
| PSY29644 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519084800000",
"number": "1235647280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 IRVINE AVE STE 111",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926603115",
"telephone_number": "714-334-5497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 IRVINE AVE STE 111",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926603115",
"telephone_number": "714-334-5497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEIL",
"first_name": "MITCHELL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-11",
"last_updated": "2018-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY29644",
"primary": true
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.