NPIMap

Individual provider Active NPI

Shayne S Keddy, D.O.

  • Pain Medicine Physician
  • Potosi, MO
National Provider Identifier
1861465627
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
2001016005 Issued in MO
Practice address
24 Southtowne Dr
Potosi, MO 63664-5729
Phone
(573) 438-3737
NPI assigned
Feb 10, 2006
Last updated
Dec 17, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2001016005 MO
Pain Medicine Physician 208VP0000X 2001016005 MO Primary

Addresses

Primary practice location

24 Southtowne Dr
Potosi, MO 63664-5729

Mailing address

610 Sumpter Dr
Farmington, MO 63640-7749
Phone (573) 747-3365

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050215000019 MO Practitioner - Family PracticePractitioner - Emergency Medicine 0446202873 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
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 PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Emergency Medicine Current Accepting new patients
Great Mines Health Center CurrentSince Jul 1, 2024 Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 1, 2019 Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospitals East Communities Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Great Mines Health Center Current Accepting new patients
Mercy Hospital Jefferson CurrentSince Aug 24, 2019 Accepting new patients
Southeastern Emergency Physicians of Memphis LLC Emergency Medicine CurrentSince Jul 1, 2015 Accepting new patients
Mercy Hospital Jefferson CurrentSince Aug 24, 2019 Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 24, 2019 Accepting new patients
Potosi Emergency Group, LLC Emergency Medicine CurrentSince Jan 4, 2017 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 24, 2019 Accepting new patients
Great Mines Health Center CurrentSince Jul 1, 2024 Accepting new patients
Mercy Hospital Lincoln CurrentSince Jul 1, 2019 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

1212 Weber Rd
Farmington, MO 63640
Phone (573) 756-3662

508 W Pine St
Farmington, MO 63640
Phone (573) 664-1100

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

1 Southtowne Dr
Potosi, MO 63664
Phone (573) 438-8401

300 Health Way Dr
Potosi, MO 63664
Phone (573) 438-2977

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

Organizations & group practices 18

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.

View all 18

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1861465627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 SUMPTER DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636407749",
            "telephone_number": "573-747-3365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 SOUTHTOWNE DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636645729",
            "telephone_number": "573-438-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDDY",
        "first_name": "SHAYNE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2001016005",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MO",
            "license": "2001016005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Potosi, MO

Sources for this page

Verify at the official NPI Registry.