Individual provider Active NPI

Patrick Keehan, D.O.

  • Dermatology Physician
  • Fort Worth, TX
National Provider Identifier
1366773889
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M4232 Issued in TX
Practice address
4625 Saint Amand Cir
Fort Worth, TX 76126-1908
Phone
(817) 769-3603
NPI assigned
Jan 22, 2010
Last updated
Mar 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M4232 TX Primary

Addresses

Primary practice location

4625 Saint Amand Cir
Fort Worth, TX 76126-1908

Mailing address

6387 Camp Bowie Blvd Ste B
# 340
Fort Worth, TX 76116-5486
Phone (817) 769-3603

Other identifiers 1

IdentifierTypeStateIssuer
213653301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100723000204 TX Practitioner - Dermatology 1850423005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of North Texas HSC, College of Osteopathic Med, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Patrick Keehan DO PAGroup PAC ID 6406286095, 3 clinicians

Practice addresses (Care Compare)

1111 5TH Ave
Fort Worth, TX 76104-4302
Phone (817) 769-3603

Merit-based Incentive Payment System (MIPS)

Final score
53.25 of 100Reported as individual
Quality
15
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision43
Removal of tissue1-10
Removal of skin lesions699
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy406

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Patrick Keehan DO PA Dermatology CurrentSince Apr 20, 2020 Accepting new patients

Locations

6387 Camp Bowie Blvd
Ste B
Ft Worth, TX 76116
Phone (817) 732-4225

1111 5th Ave
Ft Worth, TX 76104
Phone (817) 877-0200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1366773889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6387 CAMP BOWIE BLVD STE B",
            "address_2": "# 340",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165486",
            "telephone_number": "817-769-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 SAINT AMAND CIR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761261908",
            "telephone_number": "817-769-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEHAN",
        "first_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-22",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M4232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213653301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.