Individual provider Active NPI

John A Keegan, D.O.

  • Obstetrics & Gynecology Physician
  • Burnsville, MN
National Provider Identifier
1932281763
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
60476 Issued in MN
Practice address
14101 Fairview Dr
Burnsville, MN 55337-4590
Phone
(952) 993-3282
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 40890 WI
Obstetrics & Gynecology Physician 207V00000X 60476 MN Primary

Addresses

Primary practice location

14101 Fairview Dr
Burnsville, MN 55337-4590

Mailing address

14101 Fairview Dr
Burnsville, MN 55337-4590

Other practice location 1

900 Illinois Ave
Stevens Point, WI 54481-3114
Phone (715) 342-7500

Other practice location 2

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

Other identifiers 2

IdentifierTypeStateIssuer
2024OtherINTERNAL ID-MOTOR VEHICLE ID
30090500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 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
I20050511000902 WI Practitioner - Obstetrics/Gynecology 7214977933 Reassigns benefits to 1 organization
I20170816003655 MN Practitioner - Obstetrics/Gynecology 7214977933 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40890WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2017 Accepting new patients

Locations

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

5200 Fairview Blvd
Ste 1300
Wyoming, MN 55092
Phone (651) 982-7600

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1932281763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14101 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14101 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374590",
            "telephone_number": "952-993-3282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Illinois Ave",
            "address_purpose": "LOCATION",
            "city": "Stevens Point",
            "state": "WI",
            "postal_code": "544813114",
            "country_code": "US",
            "telephone_number": "715-342-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5200 Fairview Blvd",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MN",
            "postal_code": "550928013",
            "country_code": "US",
            "telephone_number": "651-982-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEEGAN",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "40890",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "60476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "2024",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30090500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.