Randall Scott Keith, M.D.
Individual provider Active NPI Family Medicine Physician · Pilot Mountain, NC
NPI 1477558542 · NPPES record last updated Jun 14, 2012
Key facts
- NPI
- 1477558542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 39630 (NC)
- Practice address
- 104 Ararat Longhill Rd
Pilot Mountain, NC 27041-8113 - Phone
- (336) 786-7966
- Fax
- (336) 786-1601
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Wake Forest University School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
104 Ararat Longhill Rd
Pilot Mountain, NC 27041-8113
Phone (336) 786-7966
Hospital & facility affiliations
- Centerwell Home Health
- Northern Regional Hospital
- Novant Health Forsyth Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 44 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20100326000209 | NC | Practitioner - Family Practice | 7517093883 | Practice locations: Pilot Mountain, NC |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39630 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holly Springs Family Practice | Family Medicine | Past |
Accepting new patients |
| Pioneer Health Services of Stokes County, Inc. | Past | Accepting new patients |
Interoperability endpoints
- randall.keith.1@15683.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39630 | NC | Yes |
Addresses
Primary practice location
104 Ararat Longhill Rd
Pilot Mountain, NC 27041-8113
Mailing address
104 Ararat Long Hill Rd
Pilot Mountain, NC 27041-8113
Phone (336) 786-7966
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8948063 | Medicaid | NC | |
| 3966 | Other | NC | PARTNERS MEDICARE |
| BCBS OF NC | Other | NC | BLUE CROSS BLUE SHIELD |
Other providers in Pilot Mountain, NC
- Michelle Hiatt
- Lee Ann Holland
- Holly Springs Family Practice
- Stephanie Cheryl Johnson
- Samantha Smith Joyce
- Kent N. Tucker,D.D.S.,P.a.
- Kidscan Therapy Services
- Sheri Ann Kretzschmar
- Kimberly Scarlet May-Sepulveda
- Selena McHone
All providers in Pilot Mountain, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2012. 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.