Individual provider Active NPI

George Keng, M.D.

  • Emergency Medicine Physician
  • Fort Atkinson, WI
National Provider Identifier
1386623684
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
42993-020 Issued in WI
Practice address
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone
(920) 568-5330
Fax
(920) 568-5075
NPI assigned
Jan 13, 2006
Last updated
Apr 16, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 42993-020 WI Primary

Addresses

Primary practice location

611 Sherman Ave E
Fort Atkinson, WI 53538-1960

Mailing address

6400 Industrial Loop
Greendale, WI 53129-2452
Phone (414) 423-4100

Other identifiers 1

IdentifierTypeStateIssuer
34099100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050927000631 WI Practitioner - Emergency Medicine 5890688360 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42993-020WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Watertown Physician Practices LLC Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Reedsburg Area Medical Center Inc CurrentSince Jul 1, 2018 Accepting new patients
Reedsburg Area Medical Center, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Madison Emergency Physicians, SC Emergency Medicine CurrentSince Jun 1, 2018 Accepting new patients
Watertown Physician Practices LLC Current Accepting new patients
Reedsburg Area Medical Center, Inc. Current Accepting new patients

Locations

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

2000 N Dewey Ave
Reedsburg, WI 53959
Phone (608) 524-6487

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111

530 Wisconsin Dells Pkwy S
Wisconsin Dells, WI 53965
Phone (608) 253-8515

Interoperability endpoints

  • Direct secure messaging: george.keng@direct.forthc.com

Organizations & group practices 6

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": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1386623684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 INDUSTRIAL LOOP",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292452",
            "telephone_number": "414-423-4100",
            "fax_number": "414-423-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SHERMAN AVE E",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381960",
            "telephone_number": "920-568-5330",
            "fax_number": "920-568-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENG",
        "first_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "42993-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34099100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.