Mary Kathryn Keenan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

002249 Issued in IA

Practice address

3701 Lafayette Rd
Evansdale, IA 50707-1129

Phone

(319) 274-7060

NPI assigned

Jan 27, 2012

Last updated

Jan 3, 2017By 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

Other identifiers 2

Other names 1

• Mary Kathryn Maggert Former name

Medicare fee-for-service enrollment

Enrolled in IA

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

Physician Assistant

Education

Southern Illinois University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104
• Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
• Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkeenan112659@direct.unitypoint.org

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.

• Iowa Physicians Clinic Medical Foundation

  dba UnityPoint Clinic

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274
  Medicare reassignment Care Compare group NPD
• Iowa Physicians Clinic Medical Foundation

  dba Unitypoint Clinic Family Medicine - Correctionville

  • Rural Health Clinic/Center
  • Correctionville, IA
  • NPI 1639061583
  NPD
• St Luke's Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

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

• Genesis Health System

  dba Genesis Medical Center Davenport

  • General Acute Care Hospital
  • Davenport, IA
  • NPI 1972542264
  Care Compare affiliation
• Trinity Medical Center

  dba Trinity Bettendorf

  • General Acute Care Hospital
  • Bettendorf, IA
  • NPI 1124110820
  Care Compare affiliation
• Trinity Medical Center

  dba Trinity Rock Island

  • General Acute Care Hospital
  • Rock Island, IL
  • NPI 1316047632
  Care Compare affiliation

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

{
    "created_epoch": "1327622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483401600000",
    "number": "1356613012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 LAFAYETTE RD",
            "city": "EVANSDALE",
            "state": "IA",
            "postal_code": "507071129",
            "telephone_number": "319-274-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 LAFAYETTE RD",
            "city": "EVANSDALE",
            "state": "IA",
            "postal_code": "507071129",
            "telephone_number": "319-274-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-27",
        "last_updated": "2017-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "002249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356613012",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01146291 GRP CC6519",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MAGGERT",
            "middle_name": "KATHRYN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Evansdale Chiropractic Clinic, PLC
• Evansdale Pharmacy, Inc.
• Chris Joe Fretheim, DC
• Iowa Physicians Clinic Medical Foundation
• Michael Clarence Kayser, DDS
• Sherry Khurana, MD
• Joseph Edward Knebel, D.C.
• Sheena Lee Kremer, NP
• Leigh Bailey Werner DDS PC (Evansdale Family Dentistry)
• Marilyn J Lies, MD

• Medical Physician Assistant in Evansdale, IA
• Providers in Evansdale, IA by specialty
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.