NPIMap

Organization Active NPI

Keith D. Jorgensen, MD, PA

  • Otolaryngology Physician
  • Derry, NH
National Provider Identifier
1679588339
Registry record updated Jul 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
7086 Issued in NH
Legal business name
KEITH D. JORGENSEN, MD, PA
Practice address
44 Birch St
Suite 304
Derry, NH 03038-2752
Phone
(603) 432-8104
Fax
(603) 434-2629
NPI assigned
Jul 30, 2006
Last updated
Jul 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2008

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

Authorized official

Name
Dr. Keith D Jorgensen, MDNPI 1023081601
Title
President
Phone
(603) 432-8104

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 7086 NH Primary

Addresses

Primary practice location

44 Birch St
Suite 304
Derry, NH 03038-2752

Mailing address

44 Birch St
Suite 304
Derry, NH 03038-2752
Phone (603) 432-8104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070206000415 NH Part B Supplier - Clinic/Group Practice 1658373568 Receives reassigned benefits from 9 practitioners
Practice locations: Derry, NH

National Provider Directory

National Provider Directory

Locations

44 Birch St
Ste 304A
Derry, NH 03038
Phone (603) 432-8104

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1679588339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 BIRCH ST",
            "address_2": "SUITE 304",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382752",
            "telephone_number": "603-432-8104",
            "fax_number": "603-434-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 BIRCH ST",
            "address_2": "SUITE 304",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382752",
            "telephone_number": "603-432-8104",
            "fax_number": "603-434-2629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH D. JORGENSEN, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "JORGENSEN",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "603-432-8104",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "NH",
            "license": "7086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derry, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.