Active NPI
Keith D. Jorgensen, MD, PA
- Otolaryngology Physician
- Derry, NH
National Provider Identifier
1679588339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 7086
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Keith D Jorgensen, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30001523 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070206000415 | NH | Part B Supplier - Clinic/Group Practice | 1658373568 |
Receives reassigned benefits from 9 practitioners Practice locations: Derry, NH |
National Provider Directory
National Provider DirectoryLocations
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.
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30001523",
"state": "NH"
}
],
"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.