Ian A Kellman, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD017470E Issued in PA

Practice address

625 Hampton Rd
Shaverton, PA 18708-9526

Phone

(570) 881-3354

Fax

(570) 696-0174

NPI assigned

Jan 26, 2006

Last updated

Jun 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Diagnostic Radiology

Education

State University of Ny Upstate Medical University, 1966

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kan-Di-Ki LLCGroup PAC ID 5991737140, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kan-Di-Ki, LLC

  dba Diagnostic Laboratories

  • Diagnostic Ultrasound Physician
  • North Hollywood, CA
  • NPI 1548422488

  PA

  Medicare reassignment Care Compare group NPD
• Community Mobile Diagnostics LLC

  dba Tridentcare

  • Diagnostic Radiology Physician
  • San Leandro, CA
  • NPI 1023104007

  NY

  Medicare reassignment
• Community Mobile Ultrasound, LLC

  dba TridentCare

  • Diagnostic Ultrasound Physician
  • Oceanside, CA
  • NPI 1760620959

  NY

  Medicare reassignment
• Kan-Di-Ki LLC

  dba Diagnostic Laboratories

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • North Hollywood, CA
  • NPI 1750364345

  NY

  Medicare reassignment
• Reono Bertagnolli a Medical Group

  dba Rely Radiology Group of California

  • Diagnostic Radiology Physician
  • San Leandro, CA
  • NPI 1134424005

  NY, PA

  Medicare reassignment
• Symphony Diagnostic Services No 1 LLC

  dba MobilexUSA

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Hunt Valley, MD
  • NPI 1700865094

  NY, PA

  Medicare reassignment
• American Diagnostics Services LLC

  dba TridentCare

  • Physiological Laboratory
  • Hunt Valley, MD
  • NPI 1487954913
  NPD
• Kan-Di-Ki LLC

  dba Diagnostic Laboratories

  • Diagnostic Ultrasound Physician
  • Phoenix, AZ
  • NPI 1992017529
  NPD

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1023088382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 HAMPTON RD",
            "city": "SHAVERTON",
            "state": "PA",
            "postal_code": "187089526",
            "telephone_number": "570-881-3354",
            "fax_number": "570-696-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 HAMPTON RD",
            "city": "SHAVERTON",
            "state": "PA",
            "postal_code": "187089526",
            "telephone_number": "570-881-3354",
            "fax_number": "570-696-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLMAN",
        "first_name": "IAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "PA",
            "license": "MD017470E",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD017470E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006544430001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.