Individual provider Active NPI

John Jacob Keyser, MD, MBA

  • Plastic and Reconstructive Surgery Physician
  • Okatie, SC
National Provider Identifier
1366788580
Registry record updated Dec 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
3817 Issued in HI
Practice address
4094 Spring Is
Okatie, SC 29909-4053
Phone
(843) 987-0616
Fax
(843) 987-3773
NPI assigned
Dec 15, 2012
Last updated
Dec 15, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 3817 HI Primary

Addresses

Primary practice location

4094 Spring Is
Okatie, SC 29909-4053

Mailing address

4094 Spring Is
Okatie, SC 29909-4053
Phone (843) 987-0616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3817HIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1355529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355529600000",
    "number": "1366788580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4094 SPRING IS",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299094053",
            "telephone_number": "843-987-0616",
            "fax_number": "843-987-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4094 SPRING IS",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299094053",
            "telephone_number": "843-987-0616",
            "fax_number": "843-987-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEYSER",
        "first_name": "JOHN",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-15",
        "last_updated": "2012-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "HI",
            "license": "3817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okatie, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.