NPIMap

Individual provider Active NPI

Keith Richard Anderson, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Hayward, WI
National Provider Identifier
1902185051
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
1017-25 Issued in WI
Practice address
11040 N State Road 77
Hayward, WI 54843-3606
Phone
(715) 934-4321
NPI assigned
Aug 8, 2011
Last updated
May 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 850 MN
Podiatrist 213E00000X 1017-25 WI
Primary Podiatric Medicine Podiatrist 213EP1101X 850 MN
Primary Podiatric Medicine Podiatrist 213EP1101X 1017-25 WI
Foot & Ankle Surgery Podiatrist 213ES0103X 850 MN
Foot & Ankle Surgery Podiatrist 213ES0103X 1017-25 WI Primary

Addresses

Primary practice location

11040 N State Road 77
Hayward, WI 54843-3606

Mailing address

11040 N State Road 77
Hayward, WI 54843-3606
Phone (715) 934-4321

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kanderson186150@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20130510000047 WI Practitioner - Podiatry 3274707252 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Services, IncGroup PAC ID 9436061363, 32 clinicians
Memorial Medical Center IncGroup PAC ID 8022000447, 80 clinicians

Practice addresses (Care Compare)

11040 N State Rd
Suite 77
Hayward, WI 54843-6391
Phone (715) 934-4245

1615 Maple LN
Ashland, WI 54806-3626
Phone (715) 682-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.19 of 100Reported as group
Quality
74.89
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.05 of 100Reported as group
Quality
87.37
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
850MNMDFoot & Ankle Surgery Podiatrist
1017-25WIMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Services, Inc CurrentSince Jul 31, 2021 Accepting new patients
Memorial Medical Center Inc CurrentSince Sep 1, 2020 Accepting new patients
Memorial Medical Center Inc CurrentSince Sep 1, 2020 Accepting new patients
Medical Services, Inc CurrentSince Jul 31, 2021 Accepting new patients
St Cloud Foot & Ankle Center PA Podiatrist PastSince Oct 7, 1996 Accepting new patients
Ri-Lee Medical Staffing, Inc. PastSince Aug 1, 2005 Accepting new patients
Doctors by Your Side Podiatrist Past Accepting new patients
Medical Services, Inc Past Accepting new patients

Locations

1615 Maple Ln
Ashland, WI 54806
Phone (715) 682-4563

11040 N State Road 77
Hayward, WI 54843
Phone (715) 934-4244

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14770/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kanderson186150@excellian.direct.allina.com

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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": "1312761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1902185051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 N STATE ROAD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433606",
            "telephone_number": "715-934-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 N STATE ROAD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433606",
            "telephone_number": "715-934-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KEITH",
        "middle_name": "RICHARD",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-08",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "850",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "1017-25",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MN",
            "license": "850",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "WI",
            "license": "1017-25",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "850",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WI",
            "license": "1017-25",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kanderson186150@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "7231 Sunwood Dr NW",
            "city": "Ramsey",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553035190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

Verify at the official NPI Registry.