Individual provider Active NPI

Anton Van Metre-Keen, PA-C

  • Physician Assistant
  • Fresno, CA
National Provider Identifier
1376277657
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA64573 Issued in CA
Practice address
7777 N Ingram Ave
Fresno, CA 93711-6281
Phone
(559) 472-7546
Fax
(559) 412-7266
NPI assigned
Jul 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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 PA64573 CA Primary

Addresses

Primary practice location

7777 N Ingram Ave
Fresno, CA 93711-6281

Mailing address

7777 N Ingram Ave
Fresno, CA 93711-6281
Phone (559) 472-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20240902000394 CA Practitioner - Physician Assistant 5799224960 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64573CAMDMarriage & Family Therapist
PA64573CAMDPhysician Assistant

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1376277657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 N INGRAM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937116281",
            "telephone_number": "559-472-7546",
            "fax_number": "559-412-7266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 N INGRAM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937116281",
            "telephone_number": "559-472-7546",
            "fax_number": "559-412-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN METRE-KEEN",
        "first_name": "ANTON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA64573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.