DR. KEITH DAVID CLANCY M.D.
NPI 1164482303
Surgery - Trauma Surgery in Fort Wayne, IN

Q: What is Keith Clancy's NPI number?

The NPI number for Keith Clancy is 1164482303. It was assigned to this individual provider in the NPPES registry on March 23, 2006.

Q: What is Keith Clancy's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Trauma Surgery, with taxonomy code 2086S0127X.

Q: When was this NPI record last updated?

The NPPES record for Keith Clancy was last updated on September 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 23, 2006PECOS EnrolledAccepts Medicare Assignment

7900 W JEFFERSON BLVD STE 306, FORT WAYNE, IN 46804(260) 458-3610(260) 458-3611 Get Directions Write a Review

NPPES record last updated: September 23, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 23, 2020, Sep 13, 2018, Oct 18, 2017 and 1 more (4 updates tracked since 2017).

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About Dr. Keith David Clancy M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEITH DAVID CLANCY M.D. (NPI 1164482303) is an individual trauma surgery provider in Fort Wayne, Indiana, licensed in Indiana (01079569A) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Baptist Health Medical Center - Jacksonville, and is a graduate of Creighton University School Of Medicine (1992).

NPPES Registry Identity

NPI1164482303

Entity TypeIndividualMale

Primary Taxonomy2086S0127X

Provider Legal NameDR. KEITH DAVID CLANCYCredential: M.D.

Location Address7900 W JEFFERSON BLVD STE 306Fort Wayne, IN 46804-4128

Mailing Address6920 Pointe Inverness Way Ste 200Fort Wayne, IN 46804-7934 · (260) 479-3514 · Fax (260) 479-3520

Phone(260) 458-3610

Fax(260) 458-3611

Sole ProprietorNo

Medical School CMSCreighton University School Of MedicineGraduated 1992

Enumeration DateMarch 23, 2006

Last NPPES UpdateSeptember 23, 20204 updates tracked since enumeration

NPPES CertifiedSeptember 23, 2020

✔ NPI 1164482303 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySurgery · Trauma SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0127X

Licenses✔ Licensed in IN · 01079569A✔ Licensed in IL · 036.090092✔ Licensed in PA · MD067578-L✔ Licensed in OH · 35.123491

Definition

Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency.

Also ListedSurgeryTaxonomy 208600000X · License MD067578-L (PA), 036.090092 (IL), 35.123491 (OH), 01079569A (IN)

Also ListedSurgery · Surgical Critical CareTaxonomy 2086S0102X · License MD067578-L (PA), 35.123491 (OH)

7900 W JEFFERSON BLVD STE 306, Fort Wayne, IN 46804

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Other Identifiers 12

Other01122002PA · Capital Blue Cross-wmg

Other491516PA · Mamsi-wmg

Other56845PA · Geisinger

Other7731206PA · Aetna

Other20006031PA · Amerihealth Mercy-wmg

Other562564PA · Highmark Blue Shield

Other610201MD · Carefirst Md Bcbs

Other039983PA · Johns Hopkins

Other0342984000PA · Amerihealth 65 Pa

Medicaid001757641PA

Other117558PA · Unison-wmg

Other1506063PA · Gateway-wmg

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL) and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Keith David Clancy M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7012947039

PECOS Enrollment IDI20230720000008

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Keith Clancy reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Florida Trauma Services, LLC

733 mi

Trauma Surgery

1703 LEWIS TURNER BLVD
Fort Walton Beach, FL 32547

Reassigned Medicare billing, Florida enrollment
77 clinicians in this Medicare group

NPI 1477296952 (850) 864-4033

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

154 services93 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

67 services67 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

56 services56 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

56 services42 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

35 services20 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

27 services27 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Baptist Health Medical Center - Jacksonville

Acute Care Hospitals · Jacksonville, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100088

Location800 Prudential DrJacksonville, FL 32207 · Duval County

Emergency services Birthing friendly

Hca Florida Lake City Hospital

Acute Care Hospitals · Lake City, FL

3/5 CMS rating

OwnershipProprietary

CMS Certification Number100156

Location340 NW Commerce DrLake City, FL 32055 · Columbia County

Emergency services

Hca Florida Orange Park Hospital

Acute Care Hospitals · Orange Park, FL

2/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number100226

Location2001 Kingsley AveOrange Park, FL 32073 · Clay County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORIA A. VAMOS PA-C

Physician Assistant