Keith A Allen, MBCHBBAO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

54561-20 Issued in WI

Practice address

15746 Fremont Way
Apple Valley, MN 55124-6531

Phone

(715) 205-6789

NPI assigned

Jul 23, 2007

Last updated

Mar 18, 2022By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Mayo Clinic Health System-Lake City

  • Multi-Specialty Clinic/Center
  • Lake City, MN
  • NPI 1164463659
  Medicare reassignment NPD
• Mayo Clinic Health System-Lake City

  • Critical Access Hospital
  • Lake City, MN
  • NPI 1538113022
  Medicare reassignment NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Bloomer

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Barron

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Oakridge, Inc.

  • Critical Access Hospital
  • Osseo, WI
  • NPI 1912958026
  NPD (past)

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1649470204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W STOUT ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548685000",
            "telephone_number": "715-234-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15746 FREMONT WAY",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551246531",
            "telephone_number": "715-205-6789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Maple Summit Rd",
            "address_purpose": "LOCATION",
            "city": "Jerseyville",
            "state": "IL",
            "postal_code": "620522028",
            "country_code": "US",
            "telephone_number": "618-498-6402",
            "fax_number": "618-498-8411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "MBCHBBAO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-23",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "51841",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036159388",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "54561-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deka Ali
• Naima Yusuf Ali
• Nasteha Awees Ali
• Nimo Ali,, MSW, LICSW
• Alizah Family Services, LLP (Alizah Family Services)
• Allina Health System (Allina Health Apple Valley Clinic)
• Allina Health System (Allina Health Apple Valley Pharmacy)
• Allina Health System (Allina Health Urgent Care Apple Valley)
• Allina Health System (Allina Health Apple Valley Pharmacy)
• Allwell Home Services

• Emergency Medicine Physician in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Emergency Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; 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.