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Keller Andrew Riede

Internal Medicine

Allopathic & Osteopathic Physicians

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

PECOS Enrollment

This provider is enrolled in PECOS as KELLER RIEDE.

Based on the most recent information from CMS, provider Keller Andrew Riede is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1871682229
Provider Type
Individual
Full Name
Riede, Keller Andrew
Title
Mr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
10/12/2006
Last Updated
7/21/2016

Contact Information

Practice Location

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

(502) 629-5552

(502) 629-3132

Mailing Location

PO Box 776351, Chicago, IL 60677-6351

(502) 588-9490

(502) 272-5116

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 39447 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 200804010	Description Other	Issuer MEDICAID - IN - NIS Indiana
ID 50020902	Description Other	Issuer PASSPORT - NIS Kentucky
ID P00641377	Description Other	Issuer RAILROAD KY MEDICARE - NIS Kentucky
ID 000000587061	Description Other	Issuer ANTHEM - NIS Kentucky
ID 099184	Description Other	Issuer SIHO - NIS Kentucky
ID 2545169	Description Other	Issuer UNITED HEALTH CARE Kentucky
ID P00265558	Description Other	Issuer MEDICARE RR Kentucky
ID 64117104	Description Medicaid	Issuer Unlisted Kentucky
ID 000000373509	Description Other	Issuer ANTHEM Kentucky
ID 000023034O	Description Other	Issuer HUMANA - NIS Kentucky
ID 00533071	Description Other	Issuer MEDICARE - NIS Kentucky
ID 2706323	Description Other	Issuer CIGNA - NIS Kentucky
ID 3856218	Description Other	Issuer AETNA HMO ONLY Kentucky
ID 64117104	Description Other	Issuer MEDICAID - NIS Kentucky
ID 7804714	Description Other	Issuer AETNA Kentucky
ID 50008029	Description Other	Issuer PASSPORT KY Kentucky

Keller Andrew Riede

PECOS Enrollment

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