Active NPI
Keita Okubo, MD, PHD
- Student in an Organized Health Care Education/Training Program
- Indianapolis, IN
National Provider Identifier
1720601941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 11022612A
- Practice address
- 545 Barnhill Dr
Indianapolis, IN 46202-5112 - Phone
- (317) 278-0394
- NPI assigned
- May 21, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transplant Surgery Physician | 204F00000X | 00000000 | AZ | |
| Surgery Physician | 208600000X | R78314 | AZ | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 11022612A | IN | Primary |
Addresses
Primary practice location
545 Barnhill Dr
Indianapolis, IN 46202-5112
Mailing address
545 Barnhill Dr
Indianapolis, IN 46202-5112
Phone (317) 278-0394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00000000 | AZ | MD | Transplant Surgery Physician |
| R78314 | AZ | MD | Surgery Physician |
| 11022612A | IN | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658880000000",
"number": "1720601941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 BARNHILL DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025112",
"telephone_number": "317-278-0394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 BARNHILL DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025112",
"telephone_number": "317-278-0394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKUBO",
"first_name": "KEITA",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-21",
"last_updated": "2022-07-27",
"certification_date": "2022-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "204F00000X",
"taxonomy_group": "",
"desc": "Transplant Surgery",
"state": "AZ",
"license": "00000000",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "R78314",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IN",
"license": "11022612A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.