Individual provider Active NPI

Jacob Bradley Keith, AGACNP

  • Acute Care Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1285300541
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
306974 Issued in AZ
Practice address
500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220
Phone
(602) 406-4000
Fax
(602) 406-6498
NPI assigned
Aug 18, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 306974 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220

Mailing address

500 W Thomas Rd Ste 500
Phoenix, AZ 85013-4220
Phone (602) 406-4000

Other identifiers 1

IdentifierTypeStateIssuer
200810MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220216002790 HI Practitioner - Nurse Practitioner 1153714084 Reassigns benefits to 2 organizations
I20240514002662 AZ Practitioner - Nurse Practitioner 1153714084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph'S Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

  • St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
306974AZMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Queen'S Medical Center Current Accepting new patients
The Queens Medical Center CurrentSince Feb 14, 2022 Accepting new patients
Sjhmc Physician Services CurrentSince Jun 3, 2024 Accepting new patients
Queens University Medical Group CurrentSince Jul 21, 2022 Accepting new patients
St. Joseph'S Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
The Queens Medical Center CurrentSince Feb 14, 2022 Accepting new patients
Kwokman Diagnostics LLC PastSince Aug 1, 2021 Accepting new patients

Locations

485 S Dobson Rd
Ste 100
Chandler, AZ 85224
Phone (602) 406-4000

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

500 W Thomas Rd
Ste 500
Phoenix, AZ 85013
Phone (602) 406-4000

File 56765
Los Angeles, CA 90074

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

550 S Beretania St
Ste 702
Honolulu, HI 96813
Phone (808) 691-8808

Interoperability endpoints

  • Direct secure messaging: jacob.keith@620069265145860.direct.elationemr.com

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 and National Provider Directory roles.

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": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772150400000",
    "number": "1285300541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134220",
            "telephone_number": "602-406-4000",
            "fax_number": "602-406-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134220",
            "telephone_number": "602-406-4000",
            "fax_number": "602-406-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH",
        "first_name": "JACOB",
        "middle_name": "BRADLEY",
        "name_prefix": "Mr.",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-18",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "306974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200810",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.