Individual provider Active NPI

Brandon Keithley, DO

  • Emergency Medicine Physician
  • Charleston, SC
National Provider Identifier
1235815101
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
LL89971 Issued in SC
Practice address
169 Ashley Avenue
Room 202 Main Hospital, Msc333
Charleston, SC 29425
Phone
(843) 876-8023
Fax
(843) 792-9706
NPI assigned
Jun 26, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X LL89971 SC Primary

Addresses

Primary practice location

169 Ashley Avenue
Room 202 Main Hospital, Msc333
Charleston, SC 29425

Mailing address

169 Ashley Avenue
Room 202 Main Hospital, Msc333
Charleston, SC 29425
Phone (843) 876-8023

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260616003904 SC Practitioner - Emergency Medicine 9739539529

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Rocky Vista University College of Osteopathic Med, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

115 Atrium Way
Suite 235
Columbia, SC 29223-6383

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL89971SCMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1235815101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVENUE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-876-8023",
            "fax_number": "843-792-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVENUE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-876-8023",
            "fax_number": "843-792-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITHLEY",
        "first_name": "BRANDON",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL89971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.