NPIMap

Individual provider Active NPI

Scott T Keller, DO

  • Family Medicine Physician
  • Lilburn, GA
National Provider Identifier
1609861830
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
024445 Issued in GA
Practice address
4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130
Phone
(770) 921-6900
Fax
(770) 921-6313
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 024445 GA Primary

Addresses

Primary practice location

4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130

Mailing address

4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130
Phone (770) 921-6900

Other identifiers 1

IdentifierTypeStateIssuer
00275272DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20070626000136 GA Practitioner - Family Practice 7214036656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mahon Family MedicineGroup PAC ID 5193970267, 2 clinicians

Practice addresses (Care Compare)

1786 Oak Rd
Suite B
Snellville, GA 30078-2220
Phone 77092525263

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024445GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Gwinnett Physician Practice Company Family Medicine Past Accepting new patients
Emory Specialty Associates, LLC Family Medicine Past Accepting new patients
Premier MD Group Inc. Family Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JHGDBD/Endpoint/JHGDBD

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 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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1609861830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE 105",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473130",
            "telephone_number": "770-921-6900",
            "fax_number": "770-921-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE 105",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473130",
            "telephone_number": "770-921-6900",
            "fax_number": "770-921-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "SCOTT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "024445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00275272D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lilburn, GA

Sources for this page

Verify at the official NPI Registry.