Active NPI
Michael R Kelly, MD
- Nephrology Physician
- Seattle, WA
National Provider Identifier
1013903780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- MD00012273
- Practice address
- 325 9TH Ave
Seattle, WA 98104-2420 - Phone
- (206) 744-5939
- NPI assigned
- Sep 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | MD00012273 | WA | Primary |
Addresses
Primary practice location
325 9TH Ave
Seattle, WA 98104-2420
Mailing address
PO Box 50095
Seattle, WA 98145-5095
Phone (206) 543-6420
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390000492 | Other | WA | RR MEDICARE |
| 78911 | Other | WA | LE |
| 0240674 | Other | WA | L&I |
| MD7023 | Other | WA | ALASKA DSHS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Kidney Centers | Past | Accepting new patients | |
| Northwest Kidney Centers | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Kent, WA
- NPI 1588378533
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Seatac, WA
- NPI 1700025038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327276800000",
"number": "1013903780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50095",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981455095",
"telephone_number": "206-543-6420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 9TH AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042420",
"telephone_number": "206-744-5939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MICHAEL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2012-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "WA",
"license": "MD00012273",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "390000492",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LE",
"identifier": "78911",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0240674",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALASKA DSHS",
"identifier": "MD7023",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.