NPIMap

Individual provider Active NPI

Kimberly Anne Keller, DO

  • Internal Medicine Physician
  • New Smyrna Beach, FL
National Provider Identifier
1366481483
Registry record updated Oct 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS10013 Issued in FL
Practice address
125 Florida Memorial Pkwy
Suite 2600
New Smyrna Beach, FL 32168-9356
Phone
(386) 409-6864
Fax
(386) 409-6813
NPI assigned
Jun 5, 2006
Last updated
Oct 22, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS10013 FL Primary

Addresses

Primary practice location

125 Florida Memorial Pkwy
Suite 2600
New Smyrna Beach, FL 32168-9356

Mailing address

125 Florida Memorial Pkwy
Suite 2600
New Smyrna Beach, FL 32168-9356
Phone (386) 409-6864

Other names 1

  • Kimberly Anne Ellis Former name

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
I20080618000253 FL Practitioner - Internal Medicine 7315995909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio University, College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS10013FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Primary Care Network Inc Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Mount Carmel Health Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Central Ohio Primary Care Physicians, Inc. Past Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

125 Florida Memorial Pkwy
Ste 2600
New Smyrna Beach, FL 32168
Phone (386) 409-6864

Interoperability endpoints

  • Direct secure messaging: kkeller71672@adventhealth.direct-ci.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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1366481483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 FLORIDA MEMORIAL PKWY",
            "address_2": "SUITE 2600",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321689356",
            "telephone_number": "386-409-6864",
            "fax_number": "386-409-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 FLORIDA MEMORIAL PKWY",
            "address_2": "SUITE 2600",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321689356",
            "telephone_number": "386-409-6864",
            "fax_number": "386-409-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS10013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ELLIS",
            "middle_name": "ANNE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Smyrna Beach, FL

Sources for this page

Verify at the official NPI Registry.