Charles Walter Kelley III, DPM

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

070000355 Issued in IN

Practice address

3401 E Raymond St
Indianapolis, IN 46203-4744

Phone

(317) 788-9769

Fax

(317) 781-4868

NPI assigned

Aug 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Charles W. Kelley III D.P.M.

  • Foot Surgery Podiatrist
  • Indianapolis, IN
  • NPI 1811142250
  NPD (past) Authorized official
• Endeavor Comprehensive Care LLC

  • Family Medicine Physician
  • Carmel, IN
  • NPI 1518675917
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1023010980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 E RAYMOND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744",
            "telephone_number": "317-788-9769",
            "fax_number": "317-781-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 E RAYMOND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744",
            "telephone_number": "317-788-9769",
            "fax_number": "317-781-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "CHARLES",
        "middle_name": "WALTER",
        "name_suffix": "III",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IN",
            "license": "070000355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100058130",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelley Medical
• Christine L Kelley-Patteson, MD
• Amanda Kelley, RN
• Anne Naus Kelley, M.S.W., L.C.S.W.
• Ashley Rachelle Kelley, CRNA
• Christina Lorraine Kelley, DPT
• Clare Kelley
• David W Kelley, MD
• Deborah Kelley, NP
• Dennis Edward Kelley, DDS

• Foot Surgery Podiatrist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Foot Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.