Terrence Joseph Keller, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11815 Issued in MN

Practice address

901 3Rd St N
Waite Park, MN 56387-1964

Phone

(320) 217-8480

Fax

(320) 217-8490

NPI assigned

Feb 17, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Rejuv Medical PAGroup PAC ID 2264598077, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: terrence.keller.1@32275.direct.athenahealth.com

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.

• Rejuv Medical, P.a.

  • Medical Specialty Clinic/Center
  • Waite Park, MN
  • NPI 1033355086
  Medicare reassignment Care Compare group
• Rejuv Savage Management

  • Clinic/Center
  • Edina, MN
  • NPI 1316344153
  Medicare reassignment NPD
• Lake Region Healthcare Corporation

  • Chiropractor
  • Fergus Falls, MN
  • NPI 1265148480
  NPD

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1861714875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 3RD ST N",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871964",
            "telephone_number": "320-217-8480",
            "fax_number": "320-217-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 3RD ST N",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871964",
            "telephone_number": "320-217-8480",
            "fax_number": "320-217-8490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "712 South Cascade",
            "address_purpose": "LOCATION",
            "city": "Fergus Falls",
            "state": "MN",
            "postal_code": "565375800",
            "country_code": "US",
            "telephone_number": "218-739-2221 x6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "TERRENCE",
        "middle_name": "JOSEPH",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-17",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.