Active NPI
Jeremy Marc Keener, D.D.S.
- Dentist
- Winnemucca, NV
National Provider Identifier
1467770537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4797
- Practice address
- 15 Paradise Ave
Winnemucca, NV 89445-2700 - Phone
- (775) 625-7763
- Fax
- (775) 623-9256
- NPI assigned
- May 13, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4797 | NV | Primary |
Addresses
Primary practice location
15 Paradise Ave
Winnemucca, NV 89445-2700
Mailing address
15 Paradise Ave
Winnemucca, NV 89445-2700
Phone (775) 625-7763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160106001704 | NV | Order and Referring Only - Other (Non-Physician) | 1850693938 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4797 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303689600000",
"number": "1467770537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 PARADISE AVE",
"city": "WINNEMUCCA",
"state": "NV",
"postal_code": "894452700",
"telephone_number": "775-625-7763",
"fax_number": "775-623-9256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 PARADISE AVE",
"city": "WINNEMUCCA",
"state": "NV",
"postal_code": "894452700",
"telephone_number": "775-625-7763",
"fax_number": "775-623-9256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEENER",
"first_name": "JEREMY",
"middle_name": "MARC",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-13",
"last_updated": "2011-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "4797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnemucca, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.