KEITH CAMERON CARLSON (MD) – Dermatology Physician, NPI 1093749640
Dermatology Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KEITH CAMERON CARLSON (MD)
200 medical plaza
#450
los angeles, CA 90095
Phone: (310) 825-0631
Type: Location
11511 NE 10TH ST
BELLEVUE, WA 980048578
Phone: (425) 502-3000
Type: Location
Kaiser Permanente - Bellevue Medical Center, 11511, Northeast 10th Street, Midlakes, Bellevue, King County, Washington, 98004, United States
BELLEVUE MEDICAL CENTER
BELLEVUE, WA 98004
Phone: (425) 502-3000
Fax: (425) 502-3589
Type: Mailing
Peter Morton Medical Building, 200, Medical Plaza Driveway, Westwood, Los Angeles, Los Angeles County, California, 90095, United States
#450
LOS ANGELES, CA 90095
Phone: (310) 825-0631
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-02-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170210001302 | I | Dermatology | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 90095)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| - | WA | |
| Family Practice | WA | |
| - | WA | |
| - | OH | |
| O P H T H A L M O L O G Y | WA | |
| Family Practice | WI | |
| Internal Medicine | OR | |
| Clinical Social Worker | WA | |
| - | WA |
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