Keenon White, MD
Individual provider Active NPI Family Medicine Physician · Bridgeville, DE
NPI 1447428636 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1447428636
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- C1-0012179 (DE)
- Practice address
- 9111 Antique Aly Unit 1
Bridgeville, DE 19933-4682 - Phone
- (302) 337-9320
- Fax
- (302) 337-9640
- NPI assigned
- Feb 11, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Tidalhealth Physician Network, Inc.
Practice addresses (Care Compare)
9111 Antique Aly
Unit 1
Bridgeville, DE 19933-4682
Phone (302) 337-9320
Hospital & facility affiliations
- Tidalhealth Home Care
- Aveanna Home Healthcare
- Amedisys Home Health
- Tidalhealth Nanticoke, Inc.
- Beebe Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170815000626 | DE | Practitioner - Family Practice | 5890910038 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NP05281400 | NJ | MD | Licensed Practical Nurse |
| C1-0012179 | DE | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 26NP05281400 | NJ | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | C1-0012179 | DE | Yes |
Addresses
Primary practice location
9111 Antique Aly Unit 1
Bridgeville, DE 19933-4682
Mailing address
9111 Antique Aly Unit 1
Bridgeville, DE 19933-4682
Phone (302) 337-9320
Other practice location 1
120 Hobart St
Residency
Utica, NY 13501-4308
Phone (315) 798-1149
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447428636 | Medicaid | DE |
Other providers in Bridgeville, DE
All providers in Bridgeville, DE · Family Medicine Physician in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.