NPIMap

Individual provider Active NPI

Angelo W Kanellos, M.D.

  • Urology Physician
  • Reno, NV
National Provider Identifier
1013008135
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
6421 Issued in NV
Practice address
10745 Double R Blvd
Reno, NV 89521-8979
Phone
(775) 850-6500
Fax
(775) 850-6501
NPI assigned
Sep 27, 2006
Last updated
Jun 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 6421 NV Primary

Addresses

Primary practice location

10745 Double R Blvd
Reno, NV 89521-8979

Mailing address

5560 Kietzke LN
BLDG a
Reno, NV 89511-3019
Phone (775) 322-7811

Other identifiers 1

IdentifierTypeStateIssuer
0020-16386MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070614000296 NV Practitioner - Urology 9739287772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Southern California Keck School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Nevada LTDGroup PAC ID 1557460557, 24 clinicians

Practice addresses (Care Compare)

5560 Kietzke LN
BLDG a
Reno, NV 89511-3019
Phone (775) 322-7811

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.42 of 100Reported as group
Quality
93.48
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Nevada LTD Urology CurrentSince Sep 1, 2007 Accepting new patients
Plumas District Hospital Past Accepting new patients
Plumas District Hospital Past Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients

Locations

10745 Double R Blvd
Reno, NV 89521
Phone (775) 322-7811

10745 Double R Blvd
#13
Reno, NV 89521
Phone (775) 322-7811

1500 E 2nd St
Ste 300
Reno, NV 89502
Phone (775) 322-7811

5560 Kietzke Ln
Reno, NV 89511
Phone (775) 284-1612

5560 Kietzke Ln
Bldg A
Reno, NV 89511
Phone (775) 322-7811

699 Sierra Rose Dr
Ste A
Reno, NV 89511
Phone (775) 689-3737

5070 Ion Dr
Ste 201
Sparks, NV 89436
Phone (775) 322-7811

Interoperability endpoints

  • Direct secure messaging: angelo.kanellos.1@19482.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19482/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/d09b5303-02b3-4cca-b4b2-ddf355d54e88/

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1013008135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5560 KIETZKE LN",
            "address_2": "BLDG A",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113019",
            "telephone_number": "775-322-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10745 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218979",
            "telephone_number": "775-850-6500",
            "fax_number": "775-850-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANELLOS",
        "first_name": "ANGELO",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NV",
            "license": "6421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020-16386",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.