Samuel Kelly

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

32697602 Issued in TX

Practice address

100 Hillcrest Medical Blvd
Waco, TX 76712-8897

Phone

(254) 202-2000

NPI assigned

Mar 6, 2020

Last updated

Jan 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hillcrest Hospital Hospital, Mayfield Heights, OH, CCN 360230

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skelly387647@ehrdirect.uhhospitals.org

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.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group
• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414
  Medicare reassignment NPD
• University Primary Care Practices Inc

  • Gastroenterology Physician
  • Mentor, OH
  • NPI 1003935339
  Medicare reassignment NPD
• University Primary Care Practices Inc

  dba Uhmp

  • Internal Medicine Physician
  • Shaker Heights, OH
  • NPI 1720220098
  NPD
• University Primary Care Practices Inc

  dba Center for Orthopedics

  • Orthopaedic Surgery Physician
  • Oberlin, OH
  • NPI 1982727087
  NPD

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

• Cleveland Clinic Health System - East Region

  dba Hillcrest Hospital

  • General Acute Care Hospital
  • Mayfield HTS, OH
  • NPI 1902858152
  Care Compare affiliation

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

{
    "created_epoch": "1583452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1013542372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HILLCREST MEDICAL BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128897",
            "telephone_number": "254-202-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-06",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "TX",
            "license": "32697602",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skelly662416@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Hillcrest Medical Blvd",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767128897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Breanna Michelle Kelley
• Lance P Kelley, PH.D.
• Ashley Mechelle Kelly
• Jack Kelly, DMD
• Mendy Kelly, LCSW
• Shannon Marie Kelly, SLP
• Dustin Dwain Kelm, PT, DPT
• Carol Ann Kemp, LCSW
• Karen Cervenka Kemper, MD
• Annika Kempf, MD

• Anesthesiologist Assistant in Waco, TX
• Providers in Waco, TX by specialty
• Anesthesiologist Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.