Keith Arlyn Fenderson, M.D

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G42277 Issued in CA

Practice address

1 Medical Plaza Dr
Roseville, CA 95661-3037

Phone

(916) 781-1000

NPI assigned

Jul 18, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1902824873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST",
            "address_2": "STE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081826",
            "telephone_number": "510-350-2600",
            "fax_number": "510-879-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PLAZA DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613037",
            "telephone_number": "916-781-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDERSON",
        "first_name": "KEITH",
        "middle_name": "ARLYN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G42277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G422770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Fehrenbacher, M.D.
• Theodor Feinstat, MD
• Karlorico Feliciano
• Bryant Felix
• Stefany Felix
• Ingrid Christina Feng
• James Xinmeng Feng, MD
• Shuwen Feng
• Yiyu Feng, MD
• Robin Patricia Fennel, LCSW

• Emergency Medicine Physician in Roseville, CA
• Providers in Roseville, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.