Keneisha Dean

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

903945 Issued in MS

Practice address

1668 W Peace St
Canton, MS 39046-5332

Phone

(662) 859-5213

NPI assigned

Jul 27, 2020

Last updated

Jul 27, 2020By the provider in NPPES

Sex

Female

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

Enrolled in MS

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

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

G a Carmichael Family Health Center, Inc.Group PAC ID 2567371032, 23 clinicians

MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Central Mississippi Health Services, IncGroup PAC ID 2961398029, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Merit Health Madison Hospital, Canton, MS, CCN 250038

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1730120502

  Family Medicine

  Medicare reassignment Care Compare group NPD
• G a Carmichael Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Canton, MS
  • NPI 1801952809
  Medicare reassignment Care Compare group
• MDB Behavioral Health Services LLC

  dba Complete Care Rural Health Clinic

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1669835310
  Care Compare group
• Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1003470758

  Family Medicine

  NPD
• Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1386301059
  NPD
• G a Carmichael Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Yazoo City, MS
  • NPI 1215128046

  Family Medicine

  NPD
• G a Carmichael Family Health Center. Inc.

  • Federally Qualified Health Center (FQHC)
  • Yazoo City, MS
  • NPI 1548327463

  Family Medicine

  NPD (past)

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

• State of Mississippi - University of Mississippi Medical Center

  dba Merit Health Madison

  • General Acute Care Hospital
  • Canton, MS
  • NPI 1194770404
  Care Compare affiliation

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1295344224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 FOREST LN",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574134",
            "telephone_number": "662-299-9517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 W PEACE ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390465332",
            "telephone_number": "662-859-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "KENEISHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "903945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Clear Eye Care, LLC
• Davis Family Health Care
• Elicia Davis, SOCIAL WORK
• Guinn Terry Davis, RPH
• Jorri Shonte Davis, FNP-C
• Kenyatta Yamisse Dent, MS, LPC
• Dental Solutions of Mississippi P.a.
• Dependable Medical Equipment
• Desmond & Puller Adult Daycare Center, LLC
• Adrianne Michelle Devine, FNP-C

• Family Medicine Physician in Canton, MS
• Providers in Canton, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.