Keith Matthew Bubb

Primary specialty

DriverTaxonomy code 172A00000X

License

N564173836715 Issued in MN

Practice address

606 Highway 123 W
Sandstone, MN 55072-5060

Phone

(320) 204-5535

Fax

(320) 216-7638

NPI assigned

Feb 8, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Attaboys, Inc

  • Non-emergency Medical Transport (VAN)
  • Sandstone, MN
  • NPI 1669603742
  NPD
• Red Lion Therapy & Consultation, LLC

  • Mental Health Counselor
  • Sandstone, MN
  • NPI 1376415935
  NPD

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1487418570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550720026",
            "telephone_number": "320-245-5355",
            "fax_number": "320-216-7638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 123 W",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550725060",
            "telephone_number": "320-204-5535",
            "fax_number": "320-216-7638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBB",
        "first_name": "KEITH",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "MN",
            "license": "N564173836715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel P. Benzie, M.D.
• Brenden James Berry, PHARMD.
• Julie Lois Bjerke
• Lonny Bostrom
• Lauren Bradel-Warlick, PHD, LP
• Samantha Rose Burch
• Danielle Marie Carlin, CNP
• Sheila Ann Carr
• Heidi Sue Cavagnetto, OTR
• James Cederstrom

• All providers in Sandstone, MN
• Driver in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.