Individual provider Active NPI

Patrick Raymond Keller, M.D.

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1801817499
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
41469-020 Issued in WI
Practice address
725 American Ave
Waukesha, WI 53188-5031
Phone
(262) 928-2400
Fax
(414) 235-4766
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 41469-020 WI Primary

Addresses

Primary practice location

725 American Ave
Waukesha, WI 53188-5031

Mailing address

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-2400

Other identifiers 1

IdentifierTypeStateIssuer
34166900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040707001279 WI Practitioner - Diagnostic Radiology 8921086927 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Wisconsin, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians
Radiology Waukesha SCGroup PAC ID 3274520648, 29 clinicians

Practice addresses (Care Compare)

109 Air Park Dr
Watertown, WI 53094-7400
Phone (262) 928-5100

1185 Corporate Ctr Dr
Suite 175
Oconomowoc, WI 53066-4889
Phone (262) 928-8400

125 Hospital Dr
Watertown, WI 53098-3303
Phone (920) 262-4659

18905 W Capitol Dr
Suite 110
Brookfield, WI 53045-2752
Phone (866) 432-7855

240 Maple Ave
Mukwonago, WI 53149-8475
Phone (262) 928-1854

2900 Golf Rd
FL 3
Pewaukee, WI 53072-5449
Phone (262) 523-0310

717 W Moreland Blvd
Waukesha, WI 53188-2432
Phone (262) 542-9100

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-2400

N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 928-4704

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Oconomowoc Memorial Hospital Hospital, Oconomowoc, WI, CCN 520062
  • Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41469-020WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Waukesha S.C. Diagnostic Radiology CurrentSince Feb 1, 2007 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Sep 15, 2008 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients
Radiology Associates of Milwaukee, S.C. Diagnostic Radiology Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Interoperability endpoints

  • Direct secure messaging: pkeller14678@direct.phci.org

Organizations & group practices 4

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 5

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1801817499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2400",
            "fax_number": "414-235-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 AMERICAN AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531885031",
            "telephone_number": "262-928-2400",
            "fax_number": "414-235-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "PATRICK",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "41469-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34166900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.