Mary Louise Keller, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-02213 Issued in NC

Practice address

4000 S Swaim Street Ext
Jonesville, NC 28642-9418

Phone

(336) 835-6300

Fax

(336) 835-4761

NPI assigned

Feb 15, 2010

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 NC

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

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of Surry and Surry County Welfare DepartmentGroup PAC ID 3274550439, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• County of Surry & Surry County Welfare Department

  • Public Health or Welfare Agency
  • Dobson, NC
  • NPI 1790825206
  Medicare reassignment Care Compare group NPD
• Wake Forest Health Network LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756
  Medicare reassignment
• Cornerstone Health Care, LLC

  • Family Medicine Physician
  • High Point, NC
  • NPI 1730587874
  NPD
• Wake Forest Health Network, LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1053175299
  NPD
• Cornerstone Health Care PA

  • Cardiovascular Disease Physician
  • Statesville, NC
  • NPI 1275914046
  NPD (past)
• Solstas Lab Partners Group LLC

  • Clinical Medical Laboratory
  • Valdosta, GA
  • NPI 1407850985
  NPD (past)

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1356663587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WESTCHESTER DR",
            "address_2": "STE. 850",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "336-802-2400",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 S SWAIM STREET EXT",
            "city": "JONESVILLE",
            "state": "NC",
            "postal_code": "286429418",
            "telephone_number": "336-835-6300",
            "fax_number": "336-835-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-15",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James E Hubbs, DO
• Hugh Chatham Memorial Hospital, Inc
• Hugh Chatham Memorial Hospital, Inc.
• Stefan Daniel Jones, DPT
• Jonesville Family Medical Center, P.a.
• Lynn D. Killon, P.A.-C.
• Kim Marie Kinsley, D.O.
• Stephanie Ann Knight
• Lam S. Chu, D.D.S., P.a.
• Jacquelinne Aguilera Maya, LCSW

• Physician Assistant in Jonesville, NC
• Providers in Jonesville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; 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.