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KELLER SKIN CARE
NPI 1649543323
Dermatology in Eagle, ID

Active since February 11, 2012
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616(208) 939-6227(208) 939-6442 Get Directions Write a Review

NPPES record last updated: November 3, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 3, 2022, Jul 21, 2022, Feb 12, 2020 and 3 more (6 updates tracked since 2017).

About Keller Skin Care NPPES

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

KELLER SKIN CARE (NPI 1649543323) is a healthcare organization registered as a dermatology in Eagle, Idaho and active in the NPI registry since February 2012. The organization lists Wade Robert Keller, President, as its authorized official.

NPPES Registry Identity

NPI1649543323
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameKELLER SKIN & CANCER CARE PC
Location Address1605 E RIVERSIDE DRIVEEagle, ID 83616
Mailing Address1605 E Riverside DrEagle, ID 83616-6237 · (208) 939-6227 · Fax (208) 939-6442
Phone(208) 939-6227
Fax(208) 939-6442
Organization SubpartNo
Authorized OfficialWade Robert KellerPresident · (208) 939-6227
Enumeration DateFebruary 11, 2012
Last NPPES UpdateNovember 3, 20226 updates tracked since enumeration
NPPES CertifiedNovember 3, 2022
✔ NPI 1649543323 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in ID · O-0559
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
1605 E RIVERSIDE DRIVE, Eagle, ID 83616
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Other Names 1

Doing Business AsKeller Skin Care

Group Practice 2

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keller Skin Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Keller Skin Care, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Wade Keller, D.O.
Micrographic Dermatologic Surgery (MDS)
NPI 1942402169
1605 E RIVERSIDE DR
Eagle, ID 83616
(208) 939-6227
✔ PECOS✔ Accepts MedicareSame address
Heather Knutson, N.P.
Nurse Practitioner
NPI 1215936034
1605 E RIVERSIDE DRIVE
Eagle, ID 83616
(208) 939-6227
✔ PECOS✔ Accepts MedicareSame address

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

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keller Skin & Cancer Care PC's NPI number?

The NPI number for Keller Skin & Cancer Care PC is 1649543323. It was assigned to this organization in the NPPES registry on February 11, 2012. The provider is doing business as Keller Skin Care.

Where is Keller Skin & Cancer Care PC located?

Keller Skin & Cancer Care PC is located at 1605 E Riverside Drive, Eagle, ID 83616. The listed phone number is (208) 939-6227.

What is Keller Skin & Cancer Care PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Keller Skin & Cancer Care PC enrolled in Medicare?

Yes. Keller Skin & Cancer Care PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Keller Skin & Cancer Care PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Keller Skin & Cancer Care PC, in Micrographic Dermatologic Surgery (MDS) and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Keller Skin & Cancer Care PC accept?

Health plans from Moda Health Plan, Inc. list Keller Skin & Cancer Care PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Keller Skin & Cancer Care PC was last updated on November 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.