Individual provider Active NPI

William Presley Keeton III, PSY.D.

  • Psychologist
  • California, MD
National Provider Identifier
1932284072
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
05643 Issued in MD
Practice address
22593 Three Notch Rd
California, MD 20619-3054
Phone
(301) 862-2505
Fax
(301) 862-2548
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 05643 MD Primary
Clinical Psychologist 103TC0700X 1406 NC

Addresses

Primary practice location

22593 Three Notch Rd
California, MD 20619-3054

Mailing address

22593 Three Notch Rd
California, MD 20619-3054
Phone (301) 862-2505

Other identifiers 2

IdentifierTypeStateIssuer
0426MOtherNCBLUE CROSS/BLUE SHIELD
6000345MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160114001447 MD Practitioner - Clinical Psychologist 6709799547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Personalized Therapy, LLCGroup PAC ID 3072526235, 7 clinicians

Practice addresses (Care Compare)

22593 Three Notch Rd
California, MD 20619-3054

3261 Old Washington Rd
Suite 1010
Waldorf, MD 20602-3228
Phone (301) 862-2505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05643MDMDPsychologist
1406NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Personalized Therapy, LLC Psychologist CurrentSince Jan 1, 2016 Accepting new patients

Locations

22593 Three Notch Rd
California, MD 20619
Phone (301) 862-2505

3261 Old Washington Rd
Ste 1010
Waldorf, MD 20602
Phone (301) 645-0366

Organizations & group practices 1

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449532800000",
    "number": "1932284072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22593 THREE NOTCH RD",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206193054",
            "telephone_number": "301-862-2505",
            "fax_number": "301-862-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22593 THREE NOTCH RD",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206193054",
            "telephone_number": "301-862-2505",
            "fax_number": "301-862-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEETON",
        "first_name": "WILLIAM",
        "middle_name": "PRESLEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2015-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "05643",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1406",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0426M",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000345",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in California, MD

Sources for this page

Verify at the official NPI Registry.