NPIMap

Individual provider Active NPI

Susan Keen, M.D.

  • Family Medicine Physician
  • Greenville, NC
National Provider Identifier
1609891860
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20059024612 Issued in NC
Practice address
1850 W Arlington Blvd
Greenville, NC 27834-5704
Phone
(252) 413-6641
NPI assigned
Jul 12, 2006
Last updated
Nov 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200500516 NC
Family Medicine Physician 207Q00000X 20059024612 NC Primary

Addresses

Primary practice location

1850 W Arlington Blvd
Greenville, NC 27834-5704

Mailing address

PO Box 751069
Ecu Physicians
Charlotte, NC 28275-1069

Other practice location 1

101 Heart Drive
ECU Physicians Family Medicine Center
Greenville, NC 27834-8944
Phone (252) 744-4611

Other identifiers 2

IdentifierTypeStateIssuer
5903308MedicaidNC
14146OtherNCBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20061027000424 NC Practitioner - Family PracticePractitioner - Emergency Medicine 0840297289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians
Physicians East PAGroup PAC ID 1850284571, 104 clinicians
Broad River RehabilitationGroup PAC ID 3375801350, 210 clinicians

Practice addresses (Care Compare)

2303 Wellington Dr SW
Suite B
Wilson, NC 27893-8620
Phone (252) 243-6818

3681 N Main St
Suite 114
Farmville, NC 27828-1464
Phone (252) 753-7141

9120 Willow Ridge Rd
Charlotte, NC 28210-8313
Phone 82877452220027

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200500516NCMDEmergency Medicine Physician
20059024612NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians East, PA CurrentSince Aug 1, 2020 Accepting new patients
Physicians East PA CurrentSince Aug 1, 2020 Accepting new patients
North Carolina Emergency Physicians, PLLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients
Physicians East PA Past Accepting new patients

Locations

3681 North Main St
#114
Farmville, NC 27828
Phone (252) 753-7141

3681 North Main St
Ste 114
Farmville, NC 27828
Phone (252) 753-7141

1850 W Arlington Blvd
Greenville, NC 27834
Phone (252) 413-6641

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: susankeen@pepa.medalliesdirect.net

Organizations & group practices 5

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 7

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1609891860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "address_2": "ECU PHYSICIANS",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W ARLINGTON BLVD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345704",
            "telephone_number": "252-413-6641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Heart Drive",
            "address_2": "ECU Physicians Family Medicine Center",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278348944",
            "country_code": "US",
            "telephone_number": "252-744-4611",
            "fax_number": "252-744-3201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEEN",
        "first_name": "SUSAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200500516",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "20059024612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903308",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "14146",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.