Individual provider Active NPI

Kenneth J Keller, MD

  • Diagnostic Radiology Physician
  • Scottsdale, AZ
National Provider Identifier
1891781886
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25985 Issued in AZ
Practice address
3501 N Scottsdale Rd Ste 130
Scottsdale, AZ 85251-5649
Phone
(480) 425-5000
NPI assigned
Sep 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4828 ND
Diagnostic Radiology Physician 2085R0202X 25985 AZ Primary

Addresses

Primary practice location

3501 N Scottsdale Rd Ste 130
Scottsdale, AZ 85251-5649

Mailing address

PO Box 5010
Minot, ND 58702-5010
Phone (701) 857-5650

Other practice location 1

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5220

Other identifiers 1

IdentifierTypeStateIssuer
889470MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090706000168 TX Practitioner - Diagnostic Radiology 5991766206
I20160215000578 AZ Practitioner - Diagnostic Radiology 5991766206 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of North Dakota School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sonoran Radiology LTDGroup PAC ID 3375964505, 466 clinicians
Southwest Diagnostic Imaging LLCGroup PAC ID 7416946199, 121 clinicians

Practice addresses (Care Compare)

19829 N 27TH Ave
Phoenix, AZ 85027-4001
Phone (832) 915-2534

250 E Dunlap Ave
Phoenix, AZ 85020-2825
Phone (832) 915-2534

3648 W Anthem Way
Suite A100
Anthem, AZ 85086-7002
Phone (832) 915-2534

6750 E Baywood Ave
Mesa, AZ 85206-1749
Phone (832) 915-2534

7400 E Thompson Peak Pkwy
Scottsdale, AZ 85255-4109
Phone (832) 915-2534

9003 E Shea Blvd
Scottsdale, AZ 85260-6709
Phone (832) 915-2534

9220 E Mountain View Rd
Suite 100
Scottsdale, AZ 85258-5134
Phone (480) 425-5000

Hospital & facility affiliations

  • Honorhealth Scottsdale Shea Medical Center Hospital, Scottsdale, AZ, CCN 030087

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4828NDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Apr 4, 2016 Accepting new patients
Sonoran Radiology LTD Diagnostic Radiology CurrentSince Jun 27, 2020 Accepting new patients
Quentin N Burdick Comprehensive Health Care Facility PastSince Jan 1, 2015 Accepting new patients
Prescott Radiologists LLP Past Accepting new patients
Simonmed Imaging, Incorporated Diagnostic Radiology Past Accepting new patients

Locations (25 of 48)

3648 W Anthem Way
Ste A100
Anthem, AZ 85086
Phone (623) 434-6444

2050 W Southern Ave
Apache Junction, AZ 85120
Phone (480) 237-3200

1076 W Chandler Blvd
Ste 120
Chandler, AZ 85224
Phone (480) 821-9198

16838 E Palisades Blvd
Ste C151
Fountain Hills, AZ 85268

3645 S Rome St
Ste 101
Gilbert, AZ 85297

665 N Gilbert Rd
Ste 154
Gilbert, AZ 85234
Phone (480) 507-4500

5310 W Thunderbird Rd
Ste 100
Glendale, AZ 85306
Phone (602) 978-0892

6220 W Bell Rd
Ste 110
Glendale, AZ 85308
Phone (602) 547-7230

5757 W Thunderbird Rd
Ste W100
Glendale, AZ 85306
Phone (623) 931-7999

5605 W Eugie Ave
Ste 110
Glendale, AZ 85304
Phone (602) 938-2002

18275 N 59th Ave
Ste 168K
Glendale, AZ 85308
Phone (602) 889-1977

5601 W Eugie Ave
Ste 102
Glendale, AZ 85304
Phone (602) 588-3420

13555 W McDowell Rd
Ste 106
Goodyear, AZ 85395
Phone (623) 535-0917

1052 E McKellips Rd
Mesa, AZ 85203
Phone (480) 425-5080

6750 E Baywood Ave
Mesa, AZ 85206
Phone (480) 854-5000

6553 E Baywood Ave
Ste 102
Mesa, AZ 85206
Phone (480) 268-7600

6424 E Broadway Rd
Ste 101
Mesa, AZ 85206
Phone (602) 830-0619

1450 S Dobson Rd
Ste A100
Mesa, AZ 85202
Phone (480) 545-9779

10575 N Tatum Blvd
Ste C128
Paradise Vly, AZ 85253
Phone (480) 998-1490

10230 W Happy Valley Pkwy
Ste 100
Peoria, AZ 85383
Phone (623) 266-4699

2323 W Rose Garden Ln
Phoenix, AZ 85027
Phone (623) 931-7999

2222 E Highland Ave
Ste 120
Phoenix, AZ 85016
Phone (602) 977-1177

33423 N 32nd Ave
Phoenix, AZ 85085
Phone (623) 474-1600

20940 N Tatum Blvd
Ste 390
Phoenix, AZ 85050
Phone (480) 407-0060

18404 N Tatum Blvd
Ste 103
Phoenix, AZ 85032
Phone (602) 485-7490

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1891781886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5010",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587025010",
            "telephone_number": "701-857-5650",
            "fax_number": "701-857-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 N SCOTTSDALE RD STE 130",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852515649",
            "telephone_number": "480-425-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Burdick Expy W",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587014406",
            "country_code": "US",
            "telephone_number": "701-857-5220",
            "fax_number": "701-857-5245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "4828",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "25985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889470",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

Verify at the official NPI Registry.