Keenan C. Wanamaker, DO

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

3721 Issued in AZ

Practice address

7085 Sydney Curv
Montgomery, AL 36117-3509

Phone

(334) 246-4774

Fax

(334) 246-2450

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, IL, AL, KS4 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 4

Specialty

Vascular Surgery

Education

Michigan State University College of Osteopathic Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeside Heart and Vascular Center PLLCGroup PAC ID 4587832779, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Havasu Regional Medical Center Hospital, Lake Havasu City, AZ, CCN 030069
• La Paz Regional Hospital Hospital, Parker, AZ, CCN 031317
• Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keenan.wanamaker.1@3291.direct.athenahealth.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://api.platform.athenahealth.com/3291/brand/1/csg/1/fhir/r4

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.

• Lakeside Heart and Vascular Center PLLC

  • Interventional Cardiology Physician
  • Lake Havasu City, AZ
  • NPI 1801194352

  AZ

  Medicare reassignment Care Compare group NPD
• Evac LLC

  • Nephrology Physician
  • Chandler, AZ
  • NPI 1073772588

  AZ

  Medicare reassignment NPD
• Mount Sinai Community Foundation

  • Rehabilitation Hospital
  • Chicago, IL
  • NPI 1376715896

  IL

  Medicare reassignment NPD
• Mowery Clinic LLC

  • Internal Medicine Physician
  • Salina, KS
  • NPI 1790742278

  KS, Surgery

  Medicare reassignment NPD
• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886

  IL

  Medicare reassignment NPD
• Colorado Medical Group, PLLC

  • Vascular Surgery Physician
  • Fort Collins, CO
  • NPI 1356714638

  Surgery

  NPD
• Mount Sinai Community Foundation

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1225125677
  NPD
• Mount Sinai Community Foundation

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1982657854
  NPD
• Gary W Eden DO

  • Surgery Physician
  • Mesa, AZ
  • NPI 1134265226

  Surgery

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Havasu Regional Medical Center LLC

  • Rural Acute Care Hospital
  • Lake Havasu City, AZ
  • NPI 1780761866

  Hospital

  Care Compare affiliation
• Kingman Healthcare, Inc

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917

  Hospital

  Care Compare affiliation
• La Paz Regional Hospital Inc

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1053684555

  Hospital

  Care Compare affiliation
• La Paz Regional Hospital Inc., Dba Parker Podiatry

  • Podiatrist
  • Parker, AZ
  • NPI 1568875771

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1972508968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7085 SYDNEY CURV",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173509",
            "telephone_number": "334-246-4774",
            "fax_number": "334-246-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7085 SYDNEY CURV",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173509",
            "telephone_number": "334-246-4774",
            "fax_number": "334-246-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANAMAKER",
        "first_name": "KEENAN",
        "middle_name": "C.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "3721",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "DO-900",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "3721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher L. Walsh, CRNA
• Enjolique Walters
• Tametris J. Walters
• Tina Walters
• Christopher Dwayne Walton
• Amanda Nicole Ward, CRNP
• Benjamin Ward, PHARM.D.
• Bobby Frank Ward, OTR
• Louis William Ward Jr., COTA
• William Alex Ward

• All providers in Montgomery, AL
• Vascular Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.