NPIMap

Individual provider Active NPI

Keith Orval Meinecke, PA-C

  • Physician Assistant
  • Boone, NC
National Provider Identifier
1285203901
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11341 Issued in NC
Practice address
336 Deerfield Rd
Boone, NC 28607-5008
Phone
(828) 268-8951
NPI assigned
Jun 18, 2021
Last updated
Jun 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-11341 NC Primary

Addresses

Primary practice location

336 Deerfield Rd
Boone, NC 28607-5008

Mailing address

498 Thorn Tree Dr
Boone, NC 28607-8003
Phone (704) 451-3711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210928000965 NC Practitioner - Physician Assistant 7214334671 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wake Forest University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watauga Medical Center IncGroup PAC ID 2668377474, 95 clinicians

Practice addresses (Care Compare)

336 Deerfield Rd
Boone, NC 28607-5008
Phone (828) 262-4133

338 Deerfield Rd
Boone, NC 28607-5008
Phone (828) 262-4133

434 Hospital Dr
Linville, NC 28646-0787
Phone (828) 737-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-11341NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Watauga Medical Center Inc CurrentSince Jul 29, 2021 Accepting new patients
Watauga Medical Center Inc CurrentSince Jul 29, 2021 Accepting new patients
Charles a. Cannon, Jr. Memorial Hospital, Inc Current Accepting new patients
Charles a Cannon Jr Memorial Hospital Inc CurrentSince Jul 29, 2021 Accepting new patients
Charles a. Cannon, Jr. Memorial Hospital, Inc. Current Accepting new patients
Charles a. Cannon, Jr. Memorial Hospital, Inc. CurrentSince Jul 29, 2021 Accepting new patients

Locations

155 Furman Rd
Ste 101
Boone, NC 28607
Phone (828) 262-4111

336 Deerfield Rd
Boone, NC 28607
Phone (828) 263-1211

Organizations & group practices 7

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1285203901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 THORN TREE DR",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286078003",
            "telephone_number": "704-451-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 DEERFIELD RD",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286075008",
            "telephone_number": "828-268-8951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEINECKE",
        "first_name": "KEITH",
        "middle_name": "ORVAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boone, NC

Sources for this page

Verify at the official NPI Registry.