Mark Robert Keller, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30821 Issued in NC

Practice address

197 NC Highway 42 N Ste B
Asheboro, NC 27203

Phone

(336) 625-2560

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Mark R Keller Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Wake Forest University School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Oak Family Physicians PAGroup PAC ID 7911993233, 9 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/57643

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.

• White Oak Family Physicians, P.a.

  • Family Medicine Physician
  • Asheboro, NC
  • NPI 1093762577
  Medicare reassignment Care Compare group NPD
• White Oak Family Physicians, PA

  • Emergency Medicine Physician
  • Randleman, NC
  • NPI 1104925072
  NPD
• White Oak Family Physicians, PA

  • Emergency Medicine Physician
  • Asheboro, NC
  • NPI 1922193622
  NPD
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Sparta, NC
  • NPI 1750330387
  NPD (past)
• Henderson Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Henderson, NC
  • NPI 1841295904
  NPD (past)
• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  NPD (past)
• Wfubmccp Primary Care, LLC

  • Primary Care Clinic/Center
  • Mocksville, NC
  • NPI 1407007131
  NPD (past)
• United Emergency Services, Inc.

  • Emergency Medicine Physician
  • Booneville, MS
  • NPI 1326007915
  NPD (past)

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1295789535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 WHITE OAK ST",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272034710",
            "telephone_number": "336-625-1360",
            "fax_number": "336-625-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 NC HIGHWAY 42 N STE B",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "27203",
            "telephone_number": "336-625-2560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Gateway Center Dr",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272842999",
            "country_code": "US",
            "telephone_number": "336-996-2173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "30821",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "30821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8948123",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "48123",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkeller246247@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "111 Gateway Center Dr",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "KELLER",
            "middle_name": "R",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kathleen L Craven
• Katie Breeze Heald PLLC
• Cora Paulette Kearley, APRN
• Amy Jean Kearns, PA-C
• Samuel Christian Keith, D.O.
• Courtney L Kelly, M.S. CCC-SLP
• Kimberly Lynne Kenan
• Caitlyn Kendrick
• Craig Kerbo, P.T.
• Ashley Pfannenstiel Kern, DNP AGNP

• Family Medicine Physician in Asheboro, NC
• Providers in Asheboro, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.