Active NPI
Jim E Keller, PA-C
- Physician Assistant
- Idaho Springs, CO
National Provider Identifier
1477628253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2055
- Practice address
- 115 15TH Ave
Idaho Springs, CO 80452 - Phone
- (303) 567-2668
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2055 | CO | Primary |
Addresses
Primary practice location
115 15TH Ave
Idaho Springs, CO 80452
Mailing address
10251 Pennington LN
Highlands Ranch, CO 80126-5584
Phone (303) 346-5412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08576840 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2055 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202169600000",
"number": "1477628253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10251 PENNINGTON LN",
"city": "HIGHLANDS RANCH",
"state": "CO",
"postal_code": "801265584",
"telephone_number": "303-346-5412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 15TH AVE",
"city": "IDAHO SPRINGS",
"state": "CO",
"postal_code": "80452",
"telephone_number": "303-567-2668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "JIM",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2008-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "2055",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08576840",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.