Individual provider Active NPI

Michael Thomas Keegan Jr., PA-C

  • Physician Assistant
  • Falls Church, VA
National Provider Identifier
1548519143
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110004958 Issued in VA
Practice address
3300 Gallows Rd
Falls Church, VA 22042-3307
Phone
(703) 776-4001
Fax
(703) 776-7113
NPI assigned
Aug 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C04749 MD
Physician Assistant 363A00000X PA030821 DC
Physician Assistant 363A00000X 0110004958 VA Primary

Addresses

Primary practice location

3300 Gallows Rd
Falls Church, VA 22042-3307

Mailing address

PO Box 37174
Baltimore, MD 21297-3174
Phone (571) 423-5699

Other practice location 1

3800 Reservoir Rd, NW
Washington, DC 20007
Phone (202) 444-8830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130410000516 DC Practitioner - Physician Assistant 5890931182 Reassigns benefits to 2 organizations
I20160920001689 VA Practitioner - Physician Assistant 5890931182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

3300 Gallows Rd
Falls Church, VA 22042-3307

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C04749MDMDPhysician Assistant
0110004958VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince Jul 16, 2016 Accepting new patients
Inova Health Care Services CurrentSince Jul 13, 2016 Accepting new patients
Inova Health Care Services CurrentSince Jul 13, 2016 Accepting new patients

Locations

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

3600 Joseph Siewick Dr
Fairfax, VA 22033
Phone (703) 391-3037

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 4

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 2

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": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1548519143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37174",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973174",
            "telephone_number": "571-423-5699",
            "fax_number": "571-423-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423307",
            "telephone_number": "703-776-4001",
            "fax_number": "703-776-7113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Reservoir Rd, NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "20007",
            "country_code": "US",
            "telephone_number": "202-444-8830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEEGAN",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-29",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C04749",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA030821",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falls Church, VA

Sources for this page

Verify at the official NPI Registry.