NPIMap

Individual provider Active NPI

Keith W Christmon, MD

  • Family Medicine Physician
  • Troy, MI
National Provider Identifier
1821096629
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
KC067976 Issued in MI
Practice address
1627 W Big Beaver Rd
Troy, MI 48084-3501
Phone
(248) 220-1560
Fax
(248) 220-1563
NPI assigned
Jul 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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 KC067976 MI Primary

Addresses

Primary practice location

1627 W Big Beaver Rd
Troy, MI 48084-3501

Mailing address

585 South Blvd E Ste 100
Pontiac, MI 48341-3163
Phone (248) 206-1200

Other identifiers 5

IdentifierTypeStateIssuer
0806334351OtherMIBCBS BCN
080189691OtherMIRAILROAD MEDICARE
0806366101OtherMIBCN
4469855MedicaidMI
0806366101OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 14, 2013 through Jan 14, 2027

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Therapy Centers, IncGroup PAC ID 5092605717, 140 clinicians

Practice addresses (Care Compare)

33010 Northwestern Hwy
West Bloomfield, MI 48322-3634

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
KC067976MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salta of Clarkston, PLLC Family Medicine CurrentSince Sep 3, 2019 Accepting new patients
Salta, PLLC Family Medicine CurrentSince Nov 14, 2018 Accepting new patients

Locations

6483 Citation Dr
Ste B
Clarkston, MI 48346
Phone (248) 861-0010

585 South Blvd E
Ste 100
Pontiac, MI 48341
Phone (248) 206-1200

1627 W Big Beaver Rd
Troy, MI 48084
Phone (248) 220-1560

Interoperability endpoints

  • Direct secure messaging: kchristmon1228849@epic00.shdirect.org

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 11

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1821096629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 SOUTH BLVD E STE 100",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483413163",
            "telephone_number": "248-206-1200",
            "fax_number": "248-206-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 W BIG BEAVER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480843501",
            "telephone_number": "248-220-1560",
            "fax_number": "248-220-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTMON",
        "first_name": "KEITH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "KC067976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BCN",
            "identifier": "0806334351",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080189691",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "0806366101",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4469855",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0806366101",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.