NPIMap

Individual provider Active NPI

Christopher Ryan Keller, MD

  • Nephrology Physician
  • Caldwell, ID
National Provider Identifier
1255467312
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
M10236 Issued in ID
Practice address
4620 Enterprise Way Ste 101
Caldwell, ID 83605
Phone
(208) 846-8335
Fax
(208) 846-8336
NPI assigned
Feb 25, 2007
Last updated
May 16, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X M10236 ID Primary

Addresses

Primary practice location

4620 Enterprise Way Ste 101
Caldwell, ID 83605

Mailing address

3525 E Louise Dr Ste 195
Meridian, ID 83642-6303
Phone (208) 846-8335

Other practice location 1

1109 W Myrtle St Ste 100
Boise, ID 83702-6971
Phone (208) 846-8335

Other practice location 2

3525 E Louise Dr Ste 195
Meridian, ID 83642-6303
Phone (208) 846-8335

Other practice location 3

4424 E Flamingo Ave
Nampa, ID 83687-9289
Phone (208) 846-8335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20080617000395 ID Practitioner - Nephrology 4284705351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of California, San Francisco School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

1210 NW 16TH St
Fruitland, ID 83619-2202
Phone (208) 452-8600

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

4620 Enterprise Way
Suite 101
Caldwell, ID 83605-6764
Phone (208) 846-8335

520 S Eagle Rd
Meridian, ID 83642-6351

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

9580 W St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 505-2711

9850 St Lukes Dr
Nampa, ID 83687-7912

9850 W St Luke's Dr
Nampa, ID 83687-7912

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M10236IDMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jan 1, 2021 Accepting new patients
LDCD, LLC PastSince Jul 10, 2010 Accepting new patients
St Lukes Regional Medical Center PastSince Feb 1, 2017 Accepting new patients
St Lukes West LTD PastSince Feb 1, 2017 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

4620 Enterprise Way
#101
Caldwell, ID 83605
Phone (208) 454-1101

3525 E Louise Dr
Ste 195
Meridian, ID 83642

Interoperability endpoints

  • Direct secure messaging: ckeller23584@direct.slhs.org

Organizations & group practices 4

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1255467312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 E LOUISE DR STE 195",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426303",
            "telephone_number": "208-846-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 ENTERPRISE WAY STE 101",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "83605",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1109 W Myrtle St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026971",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3525 E Louise Dr Ste 195",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426303",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4424 E Flamingo Ave",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836879289",
            "country_code": "US",
            "telephone_number": "208-846-8335",
            "fax_number": "208-846-8336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "CHRISTOPHER",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-25",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "ID",
            "license": "M10236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.