NPIMap

Individual provider Active NPI

Mark R Keane, M.D.

  • Neurology Physician
  • Lewiston, ID
National Provider Identifier
1427044643
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
M7728 Issued in ID
Practice address
415 6TH St
Lewiston, ID 83501-2431
Phone
(208) 750-7474
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD00037909 WA
Neurology Physician 2084N0400X 24256 AZ
Neurology Physician 2084N0400X M7728 ID Primary

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2431

Mailing address

415 6TH Street
Lewiston, ID 83501-2424
Phone (208) 750-7462

Other practice location 1

11030 N Poinsettia Dr
Oro Valley, AZ 85737-9564
Phone (208) 750-7474

Other identifiers 4

IdentifierTypeStateIssuer
805433500MedicaidID
128039OtherWAL & I WA
7088867MedicaidWA
8239543MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091215000438 ID Practitioner - Neurology 3870586126 Reassigns benefits to 1 organization
I20230516002831 AZ Practitioner - Neurology 3870586126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Arizona College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

11030 N Poinsettia Dr
Oro Valley, AZ 85737-9564
Phone (520) 575-5986

307 Saint Johns Way
Suite 1
Lewiston, ID 83501-2435
Phone (208) 743-3998

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24256AZMDNeurology Physician
M7728IDMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Hospital LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mark.keane.1@16883.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1427044643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH STREET",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012424",
            "telephone_number": "208-750-7462",
            "fax_number": "208-750-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-750-7474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11030 N Poinsettia Dr",
            "address_purpose": "LOCATION",
            "city": "Oro Valley",
            "state": "AZ",
            "postal_code": "857379564",
            "country_code": "US",
            "telephone_number": "208-750-7474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEANE",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD00037909",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "24256",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ID",
            "license": "M7728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805433500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I WA",
            "identifier": "128039",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7088867",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8239543",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.