Individual provider Active NPI

Keith F Watson, M.D

  • Nephrology Physician
  • Bloomington, IN
National Provider Identifier
1972540557
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01088351A Issued in IN
Practice address
550 S Landmark Ave
Bloomington, IN 47403-3239
Phone
(812) 676-4660
Fax
(812) 676-4501
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X C0223 KY
Nephrology Physician 207RN0300X E-11140 AR
Nephrology Physician 207RN0300X MD0000035914 TN
Nephrology Physician 207RN0300X 01088351A IN Primary

Addresses

Primary practice location

550 S Landmark Ave
Bloomington, IN 47403-3239

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

911 Bypass Rd Bldg A
Pikeville, KY 41501-1689
Phone (606) 430-2208

Other practice location 2

631 Glenties Drive
Smyrna, TN 37167
Phone (615) 419-7744

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwatson@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, ND2 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
I20180517001707 AR Practitioner - Nephrology 4486827698 Reassigns benefits to 1 organization
I20190423002034 ND Practitioner - Nephrology 4486827698 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Alexius Medical CenterGroup PAC ID 8426960865, 239 clinicians

Practice addresses (Care Compare)

900 E Broadway Ave
Bismarck, ND 58501-4520
Phone (701) 530-7000

Hospital & facility affiliations

  • CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-11140ARMDNephrology Physician
01088351AINMDNephrology Physician
C0223KYMDNephrology Physician
MD0000035914TNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Alexius Medical Center CurrentSince Mar 22, 2019 Accepting new patients
St. Alexius Medical Center Specialist CurrentSince Mar 22, 2019 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince May 25, 2018 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince May 25, 2018 Accepting new patients

Locations

6801 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-6000

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1972540557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-676-4660",
            "fax_number": "812-676-4501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Bypass Rd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "415011689",
            "country_code": "US",
            "telephone_number": "606-430-2208",
            "fax_number": "606-218-7508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "631 Glenties Drive",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "TN",
            "postal_code": "37167",
            "country_code": "US",
            "telephone_number": "615-419-7744",
            "fax_number": "615-205-6878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "KEITH",
        "middle_name": "F",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "KY",
            "license": "C0223",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E-11140",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TN",
            "license": "MD0000035914",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01088351A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwatson@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "550 S Landmark Ave",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474033239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.