Keith Hayden Sherry, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01035255A Issued in IN

Practice address

615 N Michigan St
South Bend, IN 46601-1033

Phone

(574) 647-7459

Fax

(574) 647-3658

NPI assigned

Nov 1, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Memorial Health System, Inc.

  • Physical Therapist
  • La Porte, IN
  • NPI 1013133487
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699852996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 N MICHIGAN ST",
            "address_2": "SUITE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011244",
            "telephone_number": "574-647-1842",
            "fax_number": "574-647-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-7459",
            "fax_number": "574-647-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERRY",
        "first_name": "KEITH",
        "middle_name": "HAYDEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01035255A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2977962",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alon Shemesh, DDS
• Alyssia Shepley-Minner
• Ashley Sheppard
• Sheree L. Peglow MD PC
• Dauda Sheriff, PHARMD
• Sarina Sherry, COTA
• Kristin Shide, O.T.
• Lawrence A Shinneman, O.D.
• Ike Shipman
• Rachel Shirley, RBT

• Emergency Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.