Individual provider Active NPI

Phillip M Keeley, MD

  • Family Medicine Physician
  • Bowling Green, KY
National Provider Identifier
1417190703
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46624 Issued in KY
Practice address
130 Triple Crown CT
Bowling Green, KY 42104-8567
Phone
(270) 495-1755
NPI assigned
Apr 15, 2009
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 46624 KY
Family Medicine Physician 207Q00000X 46624 KY Primary
Internal Medicine Physician 207R00000X 46624 KY
Hospitalist Physician 208M00000X 46624 KY

Addresses

Primary practice location

130 Triple Crown CT
Bowling Green, KY 42104-8567

Mailing address

130 Triple Crown CT
Bowling Green, KY 42104-8567
Phone (270) 495-1755

Other identifiers 1

IdentifierTypeStateIssuer
207P00000XMedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20131106001917 KY Practitioner - Family PracticePractitioner - Emergency Medicine 8820257751 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46624KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Oct 10, 2013 Accepting new patients
Kentucky Post-Acute Medical Services 1 PSC Hospitalist CurrentSince Sep 1, 2019 Accepting new patients
Emergency Coverage, LLC Emergency Medicine Past Accepting new patients
Emergency Medical Care Facilities PC Emergency Medicine Past Accepting new patients

Locations

723 Burkesville Rd
Albany, KY 42602
Phone (606) 387-6421

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

1301 N Race St
Glasgow, KY 42141
Phone (270) 651-4141

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

1501 S Dixie St
Park, KY 42749
Phone (270) 786-2191

360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

907 Lamar Alexander Pkwy
Maryville, TN 37804
Phone (865) 766-8818

Organizations & group practices 5

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": "1239753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1417190703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TRIPLE CROWN CT",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421048567",
            "telephone_number": "270-495-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TRIPLE CROWN CT",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421048567",
            "telephone_number": "270-495-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEELEY",
        "first_name": "PHILLIP",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-15",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "46624",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "46624",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "46624",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KY",
            "license": "46624",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207P00000X",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.