Keith Thomas Sivertson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

M5846 Issued in ID

Practice address

100 Hospital Drive
Ketchum, ID 83340

Phone

(208) 727-8445

Fax

(298) 727-8446

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Idaho Emergency Physicians, P.a.

  • Emergency Medicine Physician
  • Meridian, ID
  • NPI 1730133208
  NPD (past)
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)
• Charles Emergency Physicians PA

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1588610166
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275560260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7010",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833407010",
            "telephone_number": "208-725-5615",
            "fax_number": "208-727-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DRIVE",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-727-8445",
            "fax_number": "298-727-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVERTSON",
        "first_name": "KEITH",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M5846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Schwing, COTA/L
• Scott Featherstone DDS PLLC
• Sarah Barnett Seppa, RD, LD, CDE
• Paula Kay Shaffer, RPH
• Stephan Arthur Siele, DC
• Alison Ellan Smart, MS, ATC
• Rene Thomas Smey, OTR/L
• Ali Smith, LCPC
• Deboarh Snider, CCH
• Joann Sorento, PH.D.

• Emergency Medicine Physician in Ketchum, ID
• Providers in Ketchum, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.