Jack D Keller, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036056531 Issued in IL

Practice address

1008 W. Cherry St.
Suite F
Marion, IL 62959

Phone

(618) 997-2919

Fax

(618) 997-6851

NPI assigned

Dec 24, 2007

Last updated

Feb 20, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: kellerj@yourcarecommunity.org

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.

• Dr Jack Keller PC

  • Family Medicine Physician
  • Marion, IL
  • NPI 1215011259
  Authorized official Same address or phone

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1467636605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 W CHERRY ST STE F",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591998",
            "telephone_number": "618-997-2919",
            "fax_number": "618-997-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 W. CHERRY ST.",
            "address_2": "SUITE F",
            "city": "MARION",
            "state": "IL",
            "postal_code": "62959",
            "telephone_number": "618-997-2919",
            "fax_number": "618-997-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JACK",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-24",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036056531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056531",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Kearney
• Isaac Kee
• Joy L. Kee, LCSW
• Jordan Keepes
• Maria Cristina Kell, L.AC., LMT
• Kelly Renee Keller, SCHOOL NURSE
• Chelsey Kellerman
• Jodi Lee Kelly, LPN
• Theresa Ann Kelly, PSY.D.
• David Kennedy, RRT

• Family Medicine Physician in Marion, IL
• Providers in Marion, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.