Keenon White, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C1-0012179 Issued in 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

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

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

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.Group PAC ID 7315901253, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Home Care Home health agency, Laurel, DE, CCN 087036
• Aveanna Home Healthcare Home health agency, Milford, DE, CCN 087039
• Amedisys Home Health Home health agency, Georgetown, DE, CCN 087034
• Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006
• Beebe Medical Center Hospital, Lewes, DE, CCN 080007

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Seaford, DE
  • NPI 1467534636
  Medicare reassignment Care Compare group

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

• Amedisys Delaware, L.L.C.

  dba Amedisys Home Health

  • Home Health Agency
  • Georgetown, DE
  • NPI 1417021700
  Care Compare affiliation
• Beebe Medical Center, Inc.

  • General Acute Care Hospital
  • Lewes, DE
  • NPI 1821196486
  Care Compare affiliation
• Peninsula Home Care at Nanticoke LLC

  • Home Health Agency
  • Laurel, DE
  • NPI 1780664953
  Care Compare affiliation
• Saints Home Healthcare, LLC

  dba Aveanna Home Health

  • Home Health Agency
  • Milford, DE
  • NPI 1487706263
  Care Compare affiliation
• Tidalhealth Nanticoke, Inc

  • General Acute Care Hospital
  • Seaford, DE
  • NPI 1245214477
  Care Compare affiliation

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1447428636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9111 ANTIQUE ALY UNIT 1",
            "city": "BRIDGEVILLE",
            "state": "DE",
            "postal_code": "199334682",
            "telephone_number": "302-337-9320",
            "fax_number": "302-337-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9111 ANTIQUE ALY UNIT 1",
            "city": "BRIDGEVILLE",
            "state": "DE",
            "postal_code": "199334682",
            "telephone_number": "302-337-9320",
            "fax_number": "302-337-9640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Hobart St",
            "address_2": "Residency",
            "address_purpose": "LOCATION",
            "city": "Utica",
            "state": "NY",
            "postal_code": "135014308",
            "country_code": "US",
            "telephone_number": "315-798-1149",
            "fax_number": "314-734-3565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "KEENON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NJ",
            "license": "26NP05281400",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C1-0012179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trulyblessedcare
• Walgreen Co (Walgreens #13003)
• Promyse T Washington
• Elizabeth Wharton
• Dorothy Wheatley

• Family Medicine Physician in Bridgeville, DE
• Providers in Bridgeville, DE by specialty
• Family Medicine Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.