NPIMap

Individual provider Active NPI

Kelly Jean Vallar, MD

  • Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1033403589
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2016023747 Issued in MO
Practice address
915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone
(314) 652-4100
NPI assigned
Jun 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 2016023747 MO
Surgery Physician 208600000X 2016023747 MO Primary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 2016023747 MO
Surgical Critical Care Physician 2086S0102X 288139 MA
Surgery Physician 208600000X 036144868 IL
Trauma Surgery Physician 2086S0127X 036144868 IL
Surgical Critical Care Physician 2086S0102X 036144868 IL

Addresses

Primary practice location

915 N Grand Blvd
Saint Louis, MO 63106-1621

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-5298

Other practice location 1

317 S 14th St
Herrin, IL 62948-3671
Phone (618) 942-2002

Other practice location 2

55 Lake Ave N
Worcester, MA 01655-0002
Phone (774) 443-7057

Other practice location 3

305 W Jackson St Ste 206
Carbondale, IL 62901-1474
Phone (618) 457-3006

Other identifiers 1

IdentifierTypeStateIssuer
200029344MedicaidMO

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address kvallar38070@sih.direct-ci.com
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University
Direct Messaging Address kvallar38070@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, MA, NH4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20170928002169 MO Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 0648572008 Reassigns benefits to 2 organizations
I20200421000354 IL Practitioner - General Surgery 0648572008 Reassigns benefits to 1 organization
I20211113000063 MA Practitioner - General Surgery 0648572008 Reassigns benefits to 4 organizations
I20230601001704 NH Practitioner - General Surgery 0648572008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Missouri, Kansas City, School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Illinois Medical Services NFPGroup PAC ID 3678677390, 331 clinicians
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians
Wentworth Douglass Physician CorporationGroup PAC ID 5496749848, 429 clinicians

Practice addresses (Care Compare)

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

789 Central Ave
Dover, NH 03820-2526
Phone (603) 610-8095

Hospital & facility affiliations

  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
  • Wentworth-Douglass Hospital Hospital, Dover, NH, CCN 300018
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036144868ILMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Surgery CurrentSince May 19, 2025 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Apr 25, 2023 Accepting new patients
Washington University CurrentSince Oct 1, 2017 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Apr 25, 2023 Accepting new patients
Steward Medical Group, Inc CurrentSince Oct 1, 2021 Accepting new patients
Umass Memorial Medical Group Inc Surgery CurrentSince Mar 1, 2026 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince Jun 1, 2020 Accepting new patients
Washington University CurrentSince Nov 1, 2017 Accepting new patients
Steward Medical Group, Inc CurrentSince Oct 1, 2021 Accepting new patients
Washington University CurrentSince Oct 1, 2017 Accepting new patients
Westchester Neurological Consultant PC Past Accepting new patients
Southern Illinois Medical Services, NFP Past Accepting new patients
Umass Memorial Medical Center, Inc. Past Accepting new patients

Locations

305 W Jackson St
Ste 206
Carbondale, IL 62901
Phone (618) 457-3006

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

317 S 14th St
Herrin, IL 62948
Phone (618) 942-2002

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

11 Nevins St
Ste 202
Brighton, MA 02135
Phone (617) 254-9991

1 Pearl St
Ste 2400
Brockton, MA 02301
Phone (508) 897-6050

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

1 General St
Lawrence, MA 01841
Phone (978) 946-8103

70 East St
Methuen, MA 01844
Phone (978) 682-1906

9 Galen St
Watertown, MA 02472
Phone (617) 562-5413

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

660 S Euclid Ave
#C
Saint Louis, MO 63110

915 N Grand Blvd
Saint Louis, MO 63106
Phone (314) 289-6434

1 Barnes Hsp Plz
Saint Louis, MO 63110
Phone (314) 273-4966

660 S Euclid Ave
#8109
Saint Louis, MO 63110
Phone (314) 362-7841

660 S Euclid Ave
Saint Louis, MO 63110

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-1700

789 Central Ave
#1
Dover, NH 03820
Phone (603) 609-6260

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

Networks

  • IA HMO C-SNP
  • IA HMO

Interoperability endpoints

  • Direct secure messaging: vallar.kelly.wdh@direct.partners.masshiway.net
  • Direct secure messaging: kvallar38070@sih.direct-ci.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 7

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": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1033403589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-5298",
            "fax_number": "888-824-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 S 14th St",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483671",
            "country_code": "US",
            "telephone_number": "618-942-2002",
            "fax_number": "618-988-9780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "774-443-7057",
            "fax_number": "508-856-4224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Jackson St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-457-3006",
            "fax_number": "618-457-3007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLAR",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MO",
            "license": "2016023747",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2016023747",
            "primary": true
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "MO",
            "license": "2016023747",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MA",
            "license": "288139",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036144868",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "IL",
            "license": "036144868",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IL",
            "license": "036144868",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200029344",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvallar38070@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "305 W Jackson St Ste 206",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1 Barnes Jewish Hospital Plz",
            "address_2": "Div Surg ACCS",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvallar38070@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "317 S 14th St",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.