Andrew Jay Keough, LCSW
Individual provider Active NPI Clinical Social Worker · Benton, AR
NPI 1851628481 · NPPES record last updated Jan 3, 2020
Key facts
- NPI
- 1851628481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4601-C (AR)
- Practice address
- 1502 Mary Kay Blvd
Benton, AR 72015-7201 - Phone
- (501) 315-3344
- NPI assigned
- Nov 3, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Birch Tree Communities Inc
Practice addresses (Care Compare)
1502 Mary Kay Blvd
Benton, AR 72015-0001
Phone (501) 315-3344
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150602000596 | AR | Practitioner - Clinical Social Worker | 1355662487 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4601-C | AR | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Birch Tree Communities, Inc | Current |
Accepting new patients | |
| Birch Tree Communities Inc | Current | Accepting new patients | |
| Birch Tree Communities, Inc | Current |
Accepting new patients | |
| Lead, Teach, Mentor LLC | Past | Accepting new patients |
Locations
1718 Hot Springs Hwy
Benton, AR 72019
Phone (501) 303-1634
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4601-C | AR | Yes |
Addresses
Primary practice location
1502 Mary Kay Blvd
Benton, AR 72015-7201
Mailing address
PO Box 1589
Benton, AR 72018-1589
Phone (501) 315-3344
Other practice location 1
1100 N University Ave
suite 200
Little Rock, AR 72207-6343
Phone (501) 686-9300
Other providers in Benton, AR
- Robert Kemper
- Andrea Michele Kendrick
- Alana Kennedy
- Rebekah Anne Kennedy
- Kenneth D Wright, MD
- Paula Kathryn Keys
- Crystal Kidd
- David Kidd
- Janey Kidd
- Kidsource Therapy
All providers in Benton, AR · Clinical Social Worker in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.