Olivia Raffaella-Anna Keenan, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601009409 Issued in MI

Practice address

21401 Allen Rd
Woodhaven, MI 48183-1665

Phone

(734) 675-0835

Fax

(734) 675-0873

NPI assigned

Aug 14, 2019

Last updated

Jan 14, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sami Abbasi DO PLLCGroup PAC ID 4688869712, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Sami Abbasi DO PLLC

  dba Downriver Dermatology Center

  • Dermatology Physician
  • Brownstown TWP, MI
  • NPI 1497079230
  Medicare reassignment Care Compare group
• Peter L. Stevenson, MD, PC

  • Specialist
  • Dearborn, MI
  • NPI 1710943683
  NPD (past)

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1275189334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21401 ALLEN RD",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481831665",
            "telephone_number": "734-675-0835",
            "fax_number": "734-675-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21401 ALLEN RD",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481831665",
            "telephone_number": "734-675-0835",
            "fax_number": "734-675-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "OLIVIA",
        "middle_name": "RAFFAELLA-ANNA",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5601009409",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601009409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kakaris Family Dentistry PC
• Alexander Athanasios Kakaris Porter, DDS
• Arestea Athanasios Kakaris, DDS
• Anijolta Kambo-Gjelaj, DDS
• Kasey Thomas, Ma, Bcba, LLC
• Meredith Keith
• Zohaib Khan, DMD
• Mary Kinsey
• Gilbert Raoul Kleiff
• Kecia Klepper

• Medical Physician Assistant in Woodhaven, MI
• Providers in Woodhaven, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.

Verify at the official NPI Registry.