NPIMap

Individual provider Active NPI

Layne Keathly, M.D.

  • Family Medicine Physician
  • Yukon, OK
National Provider Identifier
1760802177
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30642 Issued in OK
Practice address
1205 Health Center Pkwy Ste 100
Yukon, OK 73099-6396
Phone
(405) 717-5400
Fax
(405) 717-5467
NPI assigned
Apr 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30642 OK Primary

Addresses

Primary practice location

1205 Health Center Pkwy Ste 100
Yukon, OK 73099-6396

Mailing address

5300 N. Independence
Suite 280
Oklahoma City, OK 73112-5556
Phone (405) 717-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170710000945 OK Practitioner - Family Practice 4183949639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

1205 Health Ctr Pkwy
Suite 100
Yukon, OK 73099-6396
Phone (405) 717-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30642OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation Family Medicine CurrentSince Jul 31, 2017 Accepting new patients
Integris Ambulatory Care C Orporation Family Medicine Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

1205 Health Center Pkwy
Ste 100
Yukon, OK 73099
Phone (405) 350-1882

Interoperability endpoints

  • Direct secure messaging: lkeathly17649@direct.integrisok.com

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 and National Provider Directory roles.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1760802177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N. INDEPENDENCE",
            "address_2": "SUITE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "405-717-5400",
            "fax_number": "405-717-5467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 HEALTH CENTER PKWY STE 100",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996396",
            "telephone_number": "405-717-5400",
            "fax_number": "405-717-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEATHLY",
        "first_name": "LAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "30642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

Verify at the official NPI Registry.