Active NPI
Dianna M Keiserman, PA
- Physician Assistant
- Indianapolis, IN
National Provider Identifier
1295791788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10001064
- Practice address
- 550 University Blvd
Radiology Department
Indianapolis, IN 46202-5149 - Phone
- (317) 278-9729
- NPI assigned
- Apr 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1433 | WI | |
| Physician Assistant | 363A00000X | 10001064 | IN | Primary |
Addresses
Primary practice location
550 University Blvd
Radiology Department
Indianapolis, IN 46202-5149
Mailing address
714 N Senate Ave
Ste Ef100
Indianapolis, IN 46202-3763
Phone (317) 715-6402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41963600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10001064 | IN | MD | Physician Assistant |
| 1433 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242777600000",
"number": "1295791788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 N SENATE AVE",
"address_2": "STE EF100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462023763",
"telephone_number": "317-715-6402",
"fax_number": "317-715-6415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 UNIVERSITY BLVD",
"address_2": "RADIOLOGY DEPARTMENT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025149",
"telephone_number": "317-278-9729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEISERMAN",
"first_name": "DIANNA",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-24",
"last_updated": "2009-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1433",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10001064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41963600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.