Active NPI
Brandon Keithley, DO
- Emergency Medicine Physician
- Charleston, SC
National Provider Identifier
1235815101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- LL89971
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| LL89971 | SC | MD | Emergency 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.
- 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.