Keaton Robert Whitcomb, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2023-0238 Issued in NM

Practice address

1501 San Pedro Dr SE
Albuquerque, NM 87108-5153

Phone

(505) 265-1711

NPI assigned

Nov 19, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

First Choice Community Healthcare, Inc.Group PAC ID 7315854049, 51 clinicians

New Mexico Dermatology Associates PAGroup PAC ID 7911917984, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• First Choice Community Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albuquerque, NM
  • NPI 1902993132

  Multi-Specialty

  Medicare reassignment Care Compare group NPD (past)
• New Mexico Dermatology Associates, P.a.

  • Specialist
  • Albuquerque, NM
  • NPI 1982764775
  Medicare reassignment Care Compare group
• First Choice Community Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albuquerque, NM
  • NPI 1205097490

  Multi-Specialty

  NPD
• Primary Care of Albuquerque LLC

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1417780511

  Multi-Specialty

  NPD (past)
• Unm Medical Group Inc

  • Developmental Disabilities Clinic/Center
  • Albuquerque, NM
  • NPI 1851614432
  NPD (past)

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732406400000",
    "number": "1841957396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SAN PEDRO DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871085153",
            "telephone_number": "505-265-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SAN PEDRO DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871085153",
            "telephone_number": "505-265-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7704 2nd St NW",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871076755",
            "country_code": "US",
            "telephone_number": "505-890-1458",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7520 Montgomery Blvd NE Bldg D5",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871091533",
            "country_code": "US",
            "telephone_number": "505-884-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITCOMB",
        "first_name": "KEATON",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-19",
        "last_updated": "2024-11-24",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2023-0238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas E Whigham, MD
• Charissa Rae Whinery, RN
• Brian J Whippo, PA-C
• Sandra Lynn Whisler, MD
• Elizabeth Whitacre, M.D.
• Blake F White Jr., PH.D.
• Breanna White
• Brittany L White, PA-C
• Carin M White, SLP
• Carol White, LISW

• Medical Physician Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Medical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2024; 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.