Wade Robert Keller, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

O-0559 Issued in ID

Practice address

1605 E Riverside Dr
Eagle, ID 83616-6237

Phone

(208) 939-6227

Fax

(208) 939-6442

NPI assigned

Jun 1, 2007

Last updated

Nov 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)

Education

Arizona College of Osteopathic Medicine Mid Western University, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Keller Skin and Cancer Care PCGroup PAC ID 2769647759, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

98.41 of 100Reported as individual

Quality

97.11

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Keller Skin & Cancer Care PC

  dba Keller Skin Care

  • Dermatology Physician
  • Eagle, ID
  • NPI 1649543323
  Medicare reassignment Care Compare group Authorized official
• J Robert West, M.D., Inc

  dba Southern California Dermatology

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1932154788
  NPD (past)

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1942402169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 E RVERSIDE DRIVE",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-939-6227",
            "fax_number": "208-939-6442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 E RIVERSIDE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166237",
            "telephone_number": "208-939-6227",
            "fax_number": "208-939-6442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "WADE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "4692",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "O-0559",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "ID",
            "license": "O-0559",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "ID",
            "license": "O-0559",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wkeller@kellerskin.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Direct Mail Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1605 E Riverside Dr",
            "city": "Eagle",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836166237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chandler Kaye Kauffman, OD
• Michael A Kaylor, M.D.
• Austin Patrick Keaney
• Madyson Keating
• Keller Skin & Cancer Care PC (Keller Skin Care)
• David J Kelly, MD
• Lindsay Rae Kenley, NCC, LPC
• Alare Kerstetter
• Key Stone Health Care
• Keystone Home Health, LLC

• Dermatology Physician in Eagle, ID
• Providers in Eagle, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.