NPIMap

Individual provider Active NPI

Kristen Kelley, D.O.

  • Family Medicine Physician
  • Greenwich, NY
National Provider Identifier
1013272939
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
280120 Issued in NY
Practice address
1134 State Route 29
Greenwich Family Health Center
Greenwich, NY 12834-6107
Phone
(518) 692-9861
Fax
(518) 692-7947
NPI assigned
Jul 6, 2012
Last updated
Feb 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 280120 NY Primary

Addresses

Primary practice location

1134 State Route 29
Greenwich Family Health Center
Greenwich, NY 12834-6107

Mailing address

100 Park Street
Glens Falls Hospital - Credentialing
Glens Falls, NY 12801
Phone (518) 926-5924

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kristen.kelley@cdirectglensfallshosp.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150806012767 NY Practitioner - Family Practice 7517271380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Glens Falls Hospital IncGroup PAC ID 8325955974, 175 clinicians

Practice addresses (Care Compare)

1134 State Route 29
Greenwich, NY 12834-6107
Phone (518) 692-9861

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Glens Falls Hospital Inc. Family Medicine CurrentSince Sep 14, 2015 Accepting new patients
Glens Falls Hospital Inc CurrentSince Sep 14, 2015 Accepting new patients

Locations

100 Park St
Glens Falls, NY 12801
Phone (518) 926-5924

79 North St
Granville, NY 12832
Phone (518) 642-0612

1134 State Route 29
Greenwich, NY 12834
Phone (518) 692-9861

Interoperability endpoints

  • Direct secure messaging: kkelley95339@albanymed.direct-ci.com

Organizations & group practices 2

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1013272939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PARK STREET",
            "address_2": "GLENS FALLS HOSPITAL - CREDENTIALING",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "12801",
            "telephone_number": "518-926-5924",
            "fax_number": "518-926-6983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 STATE ROUTE 29",
            "address_2": "GREENWICH FAMILY HEALTH CENTER",
            "city": "GREENWICH",
            "state": "NY",
            "postal_code": "128346107",
            "telephone_number": "518-692-9861",
            "fax_number": "518-692-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KRISTEN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-06",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "280120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristen.kelley@cdirectglensfallshosp.org",
            "affiliation": "N",
            "address_1": "1134 State Route 29",
            "address_2": "Greenwich Family Health Center",
            "city": "Greenwich",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128346107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwich, NY

Sources for this page

Verify at the official NPI Registry.