NPIMap

Individual provider Active NPI

Glenn R McKeon, PA-C

  • Physician Assistant
  • Lady Lake, FL
National Provider Identifier
1366414724
Registry record updated Sep 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1759 Issued in FL
Practice address
607 Highway 466
Lady Lake, FL 32159-6338
Phone
(352) 259-7994
Fax
(352) 259-7992
NPI assigned
Feb 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1759 FL Primary

Addresses

Primary practice location

607 Highway 466
Lady Lake, FL 32159-6338

Mailing address

PO Box 1777
Lady Lake, FL 32158-1777
Phone (352) 259-7994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040203000834 FL Practitioner - Physician Assistant 6608769781 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Express Family Care Past Accepting new patients
North Florida Emergency Physicians Past Accepting new patients
Nature Coast Anesthesia Providers, P.a. PastSince Jun 1, 2021 Accepting new patients
Primary Options Inc Past Accepting new patients
Nes of Florida Inc Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1366414724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1777",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321581777",
            "telephone_number": "352-259-7994",
            "fax_number": "352-259-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 HIGHWAY 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596338",
            "telephone_number": "352-259-7994",
            "fax_number": "352-259-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEON",
        "first_name": "GLENN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA1759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

Verify at the official NPI Registry.