Keith Magnus, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20041351 Issued in IN

Practice address

10293 N Meridian St
Suite 375
Indianapolis, IN 46290-1123

Phone

(317) 581-2288

Fax

(317) 581-2295

NPI assigned

Aug 2, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 13, 2016 through Jul 13, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Willow Treatment and Recovery Center, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brownsburg, IN
  • NPI 1295281053
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205971200000",
    "number": "1629085717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10293 N MERIDIAN ST",
            "address_2": "SUITE 375",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901123",
            "telephone_number": "317-581-2288",
            "fax_number": "317-581-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10293 N MERIDIAN ST",
            "address_2": "SUITE 375",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901123",
            "telephone_number": "317-581-2288",
            "fax_number": "317-581-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNUS",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magnolia Health System IX, Inc.
• Phillip Walter Magnone, M.D.
• Magnus Dentistry, LLC
• Claudine Magnus, PSY.D.
• Julie Lynne Magnus, D.D.S
• Marcus J Magnussen, DO
• Heather Magombo
• Molly Elizabeth Magrath, MD
• Minette Magsano
• Dorvanta Arqunda Magsby, FNP-C

• Clinical Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.