Active NPI
Kim Elaine McKeon, LCSW
- Clinical Social Worker
- South Windsor, CT
National Provider Identifier
1740639467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 003015
- Practice address
- 469 Buckland Rd Ste 104
South Windsor, CT 06074-3737 - Phone
- (860) 985-2151
- NPI assigned
- Jun 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 003015 | CT | Primary |
Addresses
Primary practice location
469 Buckland Rd Ste 104
South Windsor, CT 06074-3737
Mailing address
307 Cedar Swamp Rd
Coventry, CT 06238-1068
Phone (860) 985-2151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180912000548 | CT | Practitioner - Clinical Social Worker | 8820348832 | Practice locations: Manchester, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
543 N Main St
Suite G
Manchester, CT 06042-1935
Phone (860) 985-2151
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003015 | CT | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1740639467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 CEDAR SWAMP RD",
"city": "COVENTRY",
"state": "CT",
"postal_code": "062381068",
"telephone_number": "860-985-2151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "469 BUCKLAND RD STE 104",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060743737",
"telephone_number": "860-985-2151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKEON",
"first_name": "KIM",
"middle_name": "ELAINE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-03",
"last_updated": "2022-02-22",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "003015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.
- 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.