Johnathan Michael Keller, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12012526A Issued in IN

Practice address

1130 W Michigan St
Fh204
Indianapolis, IN 46202-5209

Phone

(317) 274-0076

Fax

(317) 274-0256

NPI assigned

Jun 12, 2016

Last updated

Jun 10, 2020By 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 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Johnathon Keller DDS LLC

  dba Decatur Woods Dental

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1790300242
  NPD

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

{
    "created_epoch": "1465689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1578912341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 KENTUCKY AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462212757",
            "telephone_number": "317-946-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W MICHIGAN ST",
            "address_2": "FH204",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025209",
            "telephone_number": "317-274-0076",
            "fax_number": "317-274-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JOHNATHAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-12",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012526A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1578912341",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13885169",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN DENTAL LICENSE",
            "identifier": "12012526A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201375420",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea L Keller, NP
• Colin Keller
• Danielle Nicole Keller
• Jesse Keller
• John Wesley Keller, LAT, ATC
• Katherine Keller
• Kathryn I Keller, MD
• Kayla Keller
• Kimberly E. Keller, LMHC
• Kristin Keller, AGNP-BC

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.