Shayne S Keddy, D.O.
Individual provider Active NPI Pain Medicine Physician · Potosi, MO
NPI 1861465627 · NPPES record last updated Dec 17, 2014
Key facts
- NPI
- 1861465627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine Physician 208VP0000X
- License
- 2001016005 (MO)
- Practice address
- 24 Southtowne Dr
Potosi, MO 63664-5729 - Phone
- (573) 438-3737
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Hospital Perry
Practice addresses (Care Compare)
434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536
Hospital & facility affiliations
- Mercy Hospital Perry
- Mercy Hospital Jefferson
- Mercy Hospital Springfield
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050215000019 | MO | Practitioner - Family Practice |
0446202873 | Reassigns benefits to 9 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Great Mines Health Center | Current |
Accepting new patients | |
| Southeastern Emergency Physicians of Memphis LLC | Emergency Medicine | Current |
Accepting new patients |
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Mercy Hospital Jefferson | Current |
Accepting new patients | |
| Mercy Hospital Perry | Current |
Accepting new patients | |
| Potosi Emergency Group, LLC | Emergency Medicine | Current |
Accepting new patients |
| Mercy Hospital Perry | Current |
Accepting new patients | |
| Great Mines Health Center | Current |
Accepting new patients | |
| Mercy Hospital Perry | Emergency Medicine | Current | Accepting new patients |
| Mercy Hospital Jefferson | Current |
Accepting new patients | |
| Great Mines Health Center | Current | Accepting new patients | |
| Mercy Hospitals East Communities | Current |
Accepting new patients | |
| Mercy Hospitals East Communities | Emergency Medicine | Current |
Accepting new patients |
| Mercy Hospital Lincoln | Current |
Accepting new patients | |
| Southeastern Emergency Physicians of Memphis LLC | Emergency Medicine | Past | Accepting new patients |
| Community Health Care Associates, Inc | Past | Accepting new patients | |
| Community Health Care Associates, Inc | Past | Accepting new patients |
Locations
1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000
1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111
508 W Pine St
Farmington, MO 63640
Phone (573) 664-1100
1212 Weber Rd
Farmington, MO 63640
Phone (573) 756-3662
434 N West St
Perryville, MO 63775
Phone (573) 547-2530
300 Health Way Dr
Potosi, MO 63664
Phone (573) 438-2977
1 Southtowne Dr
Potosi, MO 63664
Phone (573) 438-8401
615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687
900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585
901 E 5th St
Washington, MO 63090
Phone (636) 239-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 2001016005 | MO | |
| Pain Medicine Physician | 208VP0000X | 2001016005 | MO | Yes |
Addresses
Primary practice location
24 Southtowne Dr
Potosi, MO 63664-5729
Mailing address
610 Sumpter Dr
Farmington, MO 63640-7749
Phone (573) 747-3365
Other providers in Potosi, MO
- Brittany Gail Huys
- Inderjit Singh MD Facp LLC
- Jeffery Johnson
- Haley Juliette
- Angela Kearns
- Emily Morgan Kelley
- Marianne Klemm
- Edward William Lake
- Carolyn Coyne Maryan
- Christopher Ryan Massey
All providers in Potosi, MO · Pain Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2014. 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.