Mark David Kettler, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD15140 Issued in OR

Practice address

820 Harrison Ave
Building FGH-3 Room 203
Boston, MA 02118

Phone

(617) 638-6610

Fax

(617) 638-6616

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as group

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Boston University Medical Center Radiologists, Inc.

  • Diagnostic Radiology Physician
  • Boston, MA
  • NPI 1134166945

  Diagnostic Radiology

  NPD (past)
• Diagnostic Radiologists PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1053368563

  Diagnostic Radiology

  NPD (past)
• Diagnostic Radiologists, PC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1780702993

  Diagnostic Radiology

  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1790790202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 HARRISON AVE",
            "address_2": "BUILDING FGH-3 ROOM 203",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 HARRISON AVE",
            "address_2": "BUILDING FGH-3 ROOM 203",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-638-6610",
            "fax_number": "617-638-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLER",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD15140",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "234438",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018593",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie Kaitlin Keswick
• Ara Ketchedjian, M.D.
• Kerunne Ketlogetswe, M.D.
• Adam Christopher Ketron, MD, PHD
• Lauren Rebecca Kett, M.D., PH.D.
• Susan Evelyn Keuker, NP
• Nancy J Keuthen, PHD
• Henry T Keutmann, M.D.
• Natasha Kewene-Hite
• Colleen Melissa Keyes, M.D., M.P.H.

• Diagnostic Radiology Physician in Boston, MA
• Providers in Boston, MA by specialty
• Diagnostic Radiology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.

Verify at the official NPI Registry.