Keith Bryan Danckaert, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01042415A Issued in IN

Practice address

4020 New Vision Dr
Fort Wayne, IN 46845-1737

Phone

(260) 423-2567

Fax

(260) 420-2415

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1497787659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9016",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451737",
            "telephone_number": "260-423-2567",
            "fax_number": "260-420-2415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 N Wabash Ave Ste 360",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IN",
            "postal_code": "469522678",
            "country_code": "US",
            "telephone_number": "765-664-3292",
            "fax_number": "765-662-7560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2246 N Pointe Dr",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "IN",
            "postal_code": "465829042",
            "country_code": "US",
            "telephone_number": "571-349-9242",
            "fax_number": "572-349-9243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DANCKAERT",
        "first_name": "KEITH",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01042415A",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IN",
            "license": "01042415A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.danckaert.d1.p1@direct.forefrontderm.nextgenshare.com",
            "affiliation": "N",
            "address_1": "4020 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451737",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.danckaert.d1.p1@direct.forefrontderm.nextgenshare.com",
            "affiliation": "N",
            "address_1": "330 N Wabash Ave Ste 360",
            "city": "Marion",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469522678",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.danckaert.d1.p1@direct.forefrontderm.nextgenshare.com",
            "affiliation": "N",
            "address_1": "2246 N Pointe Dr",
            "city": "Warsaw",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465829042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela Damian
• Erica Nicole Dammann, BCBA
• Sammantha Danaher, PA-C
• Christopher A. Danby, MD
• James A. Dance, D.MIN.
• James Michael Danias, D.O.
• Daniel & Max
• Daniel & Max, LLC
• Daniel E Krach MD PC
• Janet L Daniel, M.S.

• Dermatology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.

Verify at the official NPI Registry.