Individual provider Active NPI

Scott A Keller, MD

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1356312573
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16950 Issued in OK
Practice address
7501 Riverside Pkwy
Tulsa, OK 74136
Phone
(918) 710-4200
Fax
(918) 403-6331
NPI assigned
Jan 27, 2006
Last updated
Jul 11, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16950 OK Primary

Addresses

Primary practice location

7501 Riverside Pkwy
Tulsa, OK 74136

Mailing address

7501 Riverside Pkwy
Tulsa, OK 74136-5056
Phone (918) 710-4200

Other identifiers 1

IdentifierTypeStateIssuer
100191220AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20080416000655 OK Practitioner - Family Practice 1951489921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oral Roberts University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1000 W Boise Circle
Emergency Room
Broken Arrow, OK 74012-4900
Phone (918) 994-8000

1705 E 19TH St
Tulsa, OK 74104-5410

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy22
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16950OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Jul 1, 2011 Accepting new patients
St. John Physicians, Inc. Family Medicine CurrentSince Jul 1, 2011 Accepting new patients
St John Medical Center Inc Past Accepting new patients
St. John Broken Arrow, Inc Past Accepting new patients

Locations

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

Interoperability endpoints

  • Direct secure messaging: scott.keller@direct.stjohnhealthsystem.com

Organizations & group practices 4

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": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1356312573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365056",
            "telephone_number": "918-710-4200",
            "fax_number": "918-403-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74136",
            "telephone_number": "918-710-4200",
            "fax_number": "918-403-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "SCOTT",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "16950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100191220A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.