Rae Keashly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38837 Issued in MN

Practice address

705 Pleasant Ave S
Park Rapids, MN 56470-1440

Phone

(218) 732-2800

Fax

(218) 732-2857

NPI assigned

Jun 1, 2006

Last updated

Aug 22, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Family Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Regional Health CenterGroup PAC ID 2062326820, shared by 12 NPIs, 190 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovis Health LLC

  dba Essentia Health Moorhead Clinic

  • Family Medicine Physician
  • Moorhead, MN
  • NPI 1659617504
  Medicare reassignment NPD
• Innovis Health LLC

  dba Essentia Health-Osgood Clinic

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576

  Family Medicine

  NPD
• Innovis Health LLC

  dba Essentia Health 32nd Avenue Clinic

  • Family Medicine Physician
  • Fargo, ND
  • NPI 1578907655
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Mary's Regional Health Center

  dba Essentia Health St. Mary's-Frazee Clinic

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482

  Hospital

  Care Compare affiliation
• St Marys Regional Health Center

  dba Essentia Health Park Rapids Hwy 34 Clinic

  • Rural Health Clinic/Center
  • Park Rapids, MN
  • NPI 1730706656

  Hospital

  Care Compare affiliation
• St. Marys Regional Health Center

  dba Essentia Health St. Mary's- Detroit Lakes

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Care Compare affiliation

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313971200000",
    "number": "1497792352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 PLEASANT AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701440",
            "telephone_number": "218-732-2800",
            "fax_number": "218-732-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 PLEASANT AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701440",
            "telephone_number": "218-732-2800",
            "fax_number": "218-732-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEASHLY",
        "first_name": "RAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2011-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "38837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0403067",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "23Y87KE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "23Y89KE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIOUX VALLEY #",
            "identifier": "8050",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0106730",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "975817800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LHS/BANNERHEALTH #",
            "identifier": "MN100030",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0106547",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE #",
            "identifier": "140791",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18686",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE #",
            "identifier": "DA9041015676",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO/ARAZ #",
            "identifier": "904360",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS #",
            "identifier": "HP25788",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS #",
            "identifier": "14173",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "23Y88KE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra L Jones, PAC
• Jay Christopher Jorgenson, DDS, PA
• Don Josefson, MA, LADC
• Sriveer Kaasam, M.D.
• Anna C Kanani
• Jennifer M Keller, O.D.
• Jade Kelley, PHARMD, RPH
• Mariah Rose Kemmer
• Laura Kempnich, MSW, LGSW
• Genevieve A Keranen, CDE

• Family Medicine Physician in Park Rapids, MN
• Providers in Park Rapids, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.