KEEGAN J WHITE (PA-C) – Surgical Physician Assistant, NPI 1093445744

KEEGAN J WHITE (PA-C) is a healthcare provider. based in W henrietta, New York. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. The NPI Number for KEEGAN J WHITE (PA-C) is 1093445744

Main info

Male
4 Years Of Experience
Accepts Medicare Assignment
Name
KEEGAN J WHITE (PA-C)
NPI
1093445744
Phone
(585) 953-7296
Address
67 DERRICK DR
Enumeration Date
15 June 2022
Last Update Date
15 June 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6467978973
Graduation Year
2022 (4 years ago)
PAC ID
2567998016
Group Practice PAC ID
4082856513
Professional Enrollment ID
I20241209000962
Address ID
NY100214871NE541XXSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience21
Completeness75
Years active:3State licenses:0Digital endpointsOther names

13,243 PHYSICIAN ASSISTANT in NY

Provider Addresses for KEEGAN J WHITE (PA-C)

  • 67 DERRICK DR

    W HENRIETTA, NY 145868914

    Phone: (585) 953-7296

    Type: Mailing

  • 5141 BROADWAY

    NEW YORK, NY 100341159

    Phone: (585) 953-7296

    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: 2025-10-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241209000962IPhysician AssistantNYTBD
I20251009002088IPhysician AssistantNJTBD

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.

Verify on CMS Revalidation Lookup Tool

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 14586)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4082856513View full group profile
NameSpecialtyState
-NY
Orthopedic SurgeryNY
Orthopedic SurgeryNY
Physician AssistantNY
Orthopedic SurgeryNY
Physician AssistantSC
Physician AssistantNY
Orthopedic SurgeryNY
Orthopedic SurgeryNY
Orthopedic SurgeryNY

Reviews

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Frequently asked questions

Is KEEGAN J WHITE (PA-C) listed with a National Provider Identifier?
Yes — KEEGAN J WHITE (PA-C) has NPI 1093445744 on file in the registry.
Is there an active status for KEEGAN J WHITE (PA-C)?
For scheduling context, KEEGAN J WHITE (PA-C) is shown as active in the registry.
What kind of doctor is KEEGAN J WHITE (PA-C)?
KEEGAN J WHITE (PA-C) is associated with Surgical Physician Assistant in the directory — Clinical services aligned with this taxonomy classification.
Where in New York is KEEGAN J WHITE (PA-C) registered?
Use W Henrietta, New York as the headline location for KEEGAN J WHITE (PA-C) here.
When was this NPI issued?
Enumeration for KEEGAN J WHITE (PA-C) is noted as June 15, 2022 where the registry provides it.

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