NPIMap

Individual provider Active NPI

David M Keller II, DO

  • Family Medicine Physician
  • Rockford, MI
National Provider Identifier
1578026969
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101026809 Issued in MI
Practice address
6785 Myers Lake Ave NE Ste B
Rockford, MI 49341-7415
Phone
(616) 884-5191
Fax
(616) 884-5192
NPI assigned
Apr 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 5101026809 MI Primary

Addresses

Primary practice location

6785 Myers Lake Ave NE Ste B
Rockford, MI 49341-7415

Mailing address

6785 Myers Lake Ave NE Ste B
Rockford, MI 49341-7415
Phone (616) 884-5191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20220630002425 MI Practitioner - Family Practice 3173858370 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jeffrey R Williamson DO PCGroup PAC ID 4082632617, 2 clinicians

Practice addresses (Care Compare)

123 E Cass St
Greenville, MI 48838-1905
Phone (616) 221-4302

6785 Myers Lake NE Ave B
Rockford, MI 49341-7415
Phone (616) 884-5191

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Primary Care PLLC Family Medicine CurrentSince Jan 20, 2025 Accepting new patients
Jeffrey R Williamson DO PC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Bonners Ferry Family Medicine, PLLC Family Medicine PastSince May 1, 2007 Accepting new patients

Locations

123 E Cass St
Greenville, MI 48838
Phone (616) 221-4302

6785 Myers Lake Ave NE
Ste B
Rockford, MI 49341
Phone (616) 884-5191

6785 Myers Lake Ave NE
Rockford, MI 49341
Phone (616) 366-4234

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEDFAA/Endpoint/BEDFAA
  • Direct secure messaging: dkeller69101@direct.metrohealth.net

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1578026969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6785 MYERS LAKE AVE NE STE B",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417415",
            "telephone_number": "616-884-5191",
            "fax_number": "616-884-5192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6785 MYERS LAKE AVE NE STE B",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417415",
            "telephone_number": "616-884-5191",
            "fax_number": "616-884-5192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101026809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

Verify at the official NPI Registry.