NPIMap

Individual provider Active NPI

Keith A. Conaway, M.D.

  • Family Medicine Physician
  • Shawnee, OK
National Provider Identifier
1528035284
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19091 Issued in OK
Practice address
2508 N Harrison St
Shawnee, OK 74804-3131
Phone
(405) 585-2030
Fax
(405) 585-2859
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 19091 OK
Family Medicine Physician 207Q00000X 19091 OK Primary

Addresses

Primary practice location

2508 N Harrison St
Shawnee, OK 74804-3131

Mailing address

P.O. Box 269031
Oklahoma City, OK 73126
Phone (405) 585-2030

Other identifiers 2

IdentifierTypeStateIssuer
100131940BMedicaidOK
239727001OtherOKHOSPITALIST MED PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070927000114 OK Practitioner - Family Practice 5890688238 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prague Healthcare AuthorityGroup PAC ID 8123435187, 12 clinicians
Crossroads Medical Management LLCGroup PAC ID 4183856784, 5 clinicians

Practice addresses (Care Compare)

1322 Klabzuba Ave
Prague, OK 74864-4900
Phone (405) 567-4922

2508 N Harrison St
Shawnee, OK 74804-3131
Phone (405) 585-2030

Hospital & facility affiliations

  • Cohesive Healthcare Home health agency, Shawnee, OK, CCN 377781
  • Cohesive Healthcare Hospice, Shawnee, OK, CCN 371741
  • Prague Regional Memorial Hospital Hospital, Prague, OK, CCN 371301
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19091OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Medical Management LLC Family Medicine CurrentSince Sep 1, 2013 Accepting new patients
Prague Healthcare Authority CurrentSince Sep 1, 2021 Accepting new patients
Prague Healthcare Authority CurrentSince Sep 1, 2021 Accepting new patients
Family Medicine Specialists, P.C. Family Medicine PastSince Jul 1, 1996 Accepting new patients

Locations

1322 Klabzuba Ave
Prague, OK 74864
Phone (405) 567-2295

1900 Gordon Cooper Dr
Shawnee, OK 74801
Phone (405) 273-2240

2508 N Harrison St
Shawnee, OK 74804
Phone (405) 395-5836

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1528035284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 269031",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73126",
            "telephone_number": "405-585-2030",
            "fax_number": "405-585-2859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 N HARRISON ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748043131",
            "telephone_number": "405-585-2030",
            "fax_number": "405-585-2859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONAWAY",
        "first_name": "KEITH",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OK",
            "license": "19091",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "19091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100131940B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITALIST MED PTAN",
            "identifier": "239727001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.