Individual provider Active NPI

David W Kelley, D.O.

  • Anesthesiology Physician
  • Lafayette, IN
National Provider Identifier
1023109022
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
02003370A Issued in IN
Practice address
2600 Greenbush St
Lafayette, IN 47904-2477
Phone
(765) 448-8000
NPI assigned
Sep 27, 2006
Last updated
Oct 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X RT1190 NH
Critical Care Medicine (Anesthesiology) Physician 207LC0200X RT1190 NH
Anesthesiology Physician 207L00000X 02003370A IN Primary

Addresses

Primary practice location

2600 Greenbush St
Lafayette, IN 47904-2477

Mailing address

PO Box 5545
Lafayette, IN 47903-5545
Phone (765) 448-8000

Other identifiers 2

IdentifierTypeStateIssuer
200910690MedicaidIN
000000576532OtherINANTHEM PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170125000716 AR Practitioner - AnesthesiologyPractitioner - Osteopathic Manipulative Medicine 1658446380 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Osteopathic Manipulative Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Anesthesia Associates PLLCGroup PAC ID 6406023142, 85 clinicians

Practice addresses (Care Compare)

10201 Kanis Rd
Little Rock, AR 72205-6203
Phone (501) 227-5050

624 Hospital Dr
Mountain Home, AR 72653-2955
Phone (870) 508-1000

761 Beard Dr
Mountain Home, AR 72653-2961
Phone (870) 508-6700

9500 Kanis Rd
Suite 401
Little Rock, AR 72205-6377
Phone (501) 227-9088

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02003370AINMDAnesthesiology Physician
RT1190NHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Dec 28, 2018 Accepting new patients
University of Arkansas for Medical Sciences Anesthesiology Current Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Dec 28, 2018 Accepting new patients
Arkansas Children's Hospital CurrentSince Dec 28, 2018 Accepting new patients
Arkansas Anesthesia Associates, PLLC. Anesthesiology CurrentSince Jul 1, 2021 Accepting new patients
University of Arkansas for Medical Sciences Anesthesiology CurrentSince Dec 28, 2018 Accepting new patients
Arkansas Childrens Hospital CurrentSince Dec 28, 2018 Accepting new patients
Youngs Professional Services LLC CurrentSince Feb 7, 2022 Accepting new patients
Premier Anesthesia of Arkansas Professional Corporation Anesthesiology CurrentSince Nov 14, 2016 Accepting new patients

Locations

700 W Grove St
El Dorado, AR 71730
Phone (870) 863-2200

3215 N Northhills Blvd
Fayetteville, AR 72703
Phone (479) 463-1000

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

10301 Kanis Rd
Little Rock, AR 72205
Phone (501) 604-4151

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

2655 Northwinds Pkwy
Alpharetta, GA 30009
Phone (678) 690-7804

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Organizations & group practices 9

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223510400000",
    "number": "1023109022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5545",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479035545",
            "telephone_number": "765-448-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 GREENBUSH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042477",
            "telephone_number": "765-448-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "DAVID",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NH",
            "license": "RT1190",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "NH",
            "license": "RT1190",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "02003370A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200910690",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000576532",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.