THEPPANYA KA KEOLASY (MD) – Family Medicine Physician, NPI 1124028881
Family Medicine Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,862 FAMILY PRACTICE in IN
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Provider Addresses for THEPPANYA KA KEOLASY (MD)
Stults Road, Huntington, Huntington County, Indiana, 46750, United States
SUITE 100
HUNTINGTON, IN 467501291
Phone: (260) 356-5424
Fax: (260) 358-2090
Type: Location
1234, East Dupont Road, Fort Wayne, Allen County, Indiana, 46825, United States
SUITE 3
FORT WAYNE, IN 468251545
Phone: (260) 373-9700
Fax: (260) 373-9740
Type: Mailing
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE, IN 468451701
Phone:
Type: Mailing
577 GEIGER DR STE C
ROANOKE, IN 467838877
Phone: (260) 672-5950
Fax: (260) 672-0939
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 13 Open Payments records for all available years, with a total value of $1,010.
Total Amount is formed as General ($1,010) + Research ($0) + Ownership ($0) = $1,010.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($474).
Total Amount
$1,010
General + Research + Ownership
Payments
13
Total payment records
General Amount
$1,010
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| GlaxoSmithKline, LLC. | $474 |
| IDORSIA PHARMACEUTICALS US INC | $142 |
| Lilly USA, LLC | $121 |
| AstraZeneca Pharmaceuticals LP | $121 |
| Novo Nordisk Inc | $117 |
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: 2004-09-09
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 |
|---|---|---|---|---|
| I20040909000023 | I | Family Practice | IN | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 333 | 184 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 83 | 81 | $0 |
| 83036 | Hemoglobin a1c level | 80 | 45 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 78 | 62 | $0 |
| G0008 | Administration of influenza virus vaccine | 61 | 60 | $0 |
Insurance plans in this area (ZIP 46750)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | IN | 90670 | Pneumococcal vaccine for injection into muscle | 14 | 14 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| Nurse Practitioner | NM | |
| - | IN | |
| Nurse Practitioner | IN | |
| Family Practice | IN | |
| - | IN | |
| - | IN | |
| Infectious Disease | IN | |
| Internal Medicine | IN | |
| - | IN |
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