Mark K Keohane, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

34653 Issued in MO

Practice address

9323 Phoenix Village Pkwy
O Fallon, MO 63366-4281

Phone

(636) 561-5030

Fax

(636) 561-5033

NPI assigned

May 23, 2005

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 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Orthopedic Surgery

Education

Saint Louis University School of Medicine, 1971

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McPherson Medical and Diagnostic LLCGroup PAC ID 5698773539, shared by 11 NPIs, 88 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1710980750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9323 PHOENIX VILLAGE PKWY",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633664281",
            "telephone_number": "636-561-5030",
            "fax_number": "636-561-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9323 PHOENIX VILLAGE PKWY",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633664281",
            "telephone_number": "636-561-5030",
            "fax_number": "636-561-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOHANE",
        "first_name": "MARK",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "34653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4061116",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMR",
            "identifier": "43177",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "18883",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "122683",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DMERC",
            "identifier": "351240001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "900094",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "4434V6097",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCLUSIVE CHOICE",
            "identifier": "9043",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP/ADVANTRA",
            "identifier": "2253V3458",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "SP10133",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Marie Kemper, M.P.T.
• Kelli Kenady, DPT
• Katie Michelle Kendrick, BCBA
• Erika Kennedy, M.ED., LPC
• Martin Gerard Kennedy, PH.D.
• Jeremy M Kertz, DPT
• Katie Kessler, LCSW
• Kevin L. Threlkeld, M.D., LLC
• Chaudhary Mobin Khan, MD
• Soheel Ahmad Khan, PHARM.D.

• Orthopaedic Surgery Physician in O Fallon, MO
• Providers in O Fallon, MO by specialty
• Orthopaedic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.