Scott Asbury Kellermeyer

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

59803 Issued in GA

Practice address

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501

Phone

(770) 535-9391

Fax

(770) 533-4701

NPI assigned

Aug 20, 2006

Last updated

Mar 6, 2019By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Diagnostic Health Corporation

  dba Diagnostic Health, Orange Park

  • Physiological Laboratory
  • Orange Park, FL
  • NPI 1093764508
  NPD (past)
• Fairfield Imaging Associates, Inc

  • Diagnostic Radiology Physician
  • Lancaster, OH
  • NPI 1265763593
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1518072800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-533-6511",
            "fax_number": "770-533-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 JESSE JEWELL PKWY SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-535-9391",
            "fax_number": "770-533-4701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Jesse Jewell Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "30501",
            "country_code": "US",
            "telephone_number": "770-535-6511",
            "fax_number": "770-535-9391",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1270 Friendship Rd",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175630",
            "country_code": "US",
            "telephone_number": "770-535-9391",
            "fax_number": "770-533-4701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "655 Jesse Jewell Pkwy SE Ste B",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013854",
            "country_code": "US",
            "telephone_number": "770-535-9391",
            "fax_number": "770-533-4701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLERMEYER",
        "first_name": "SCOTT",
        "middle_name": "ASBURY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101223420",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "59803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123832240G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007223676",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0101223420",
            "identifier": "LICENSE",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kegler and Associates Family Dentistry
• Mary Watson Keith, M.D.
• Thomas L Keith, MD
• Joy Kelleher, LCSW
• Jessica Tench Keller, PA
• Clay Barton Kelley, AAC
• Michele Poole Kelly, CNM
• Paul T Kelly, ARNP
• Terri Kelly, RN, IBCLC
• Terri Penna Kemmerer, CNP

• Diagnostic Radiology Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Diagnostic Radiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.