Individual provider Active NPI

Eric J Keenly, MD

  • Anesthesiology Physician
  • Syracuse, NY
National Provider Identifier
1750306650
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
227313-1 Issued in NY
Practice address
750 E Adams St RM 4143
Syracuse, NY 13210-2306
Phone
(315) 464-4720
Fax
(315) 464-4905
NPI assigned
Jul 12, 2006
Last updated
Aug 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 227313-1 NY Primary

Addresses

Primary practice location

750 E Adams St RM 4143
Syracuse, NY 13210-2306

Mailing address

5784 Widewaters Pkwy Ste 2
Syracuse, NY 13214-1890
Phone (315) 484-4891

Other identifiers 1

IdentifierTypeStateIssuer
02369235MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050707000189 NY Practitioner - Anesthesiology 2062456098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Medical Anesthesiology Group IncGroup PAC ID 8921992389, 76 clinicians

Practice addresses (Care Compare)

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4720

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.42 of 100Reported as group
Quality
97.55
Promoting interoperability
100
Improvement activities
40
Cost
82.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
227313-1NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chag Anesthesia PC Anesthesiology CurrentSince Dec 1, 2013 Accepting new patients
Upstate Medical Anesthesiology Group, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Anesthesiology Associates of Radford Inc Anesthesiology Past Accepting new patients

Locations

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

5784 Widewaters Pkwy
Ste 2
Syracuse, NY 13214
Phone (315) 469-1134

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

750 E Adams St
Rm 4143
Syracuse, NY 13210
Phone (315) 464-4720

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1750306650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5784 WIDEWATERS PKWY STE 2",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141890",
            "telephone_number": "315-484-4891",
            "fax_number": "315-472-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST RM 4143",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-4720",
            "fax_number": "315-464-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENLY",
        "first_name": "ERIC",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "227313-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02369235",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.