Individual provider Active NPI

Jason Kelty, D.P.M.

  • Podiatrist
  • Tallmadge, OH
National Provider Identifier
1043654007
Registry record updated Jul 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36003762 Issued in OH
Practice address
116 East Ave
Suite 4
Tallmadge, OH 44278-2300
Phone
(216) 245-1290
Fax
(866) 571-4884
NPI assigned
Apr 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 36003762 OH Primary

Addresses

Primary practice location

116 East Ave
Suite 4
Tallmadge, OH 44278-2300

Mailing address

3733 Park East Dr
Suite 240
Beachwood, OH 44122-4338
Phone (216) 672-4330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160914002419 OH Practitioner - Podiatry 3577859750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Podiatry IncGroup PAC ID 6507936671, 16 clinicians

Practice addresses (Care Compare)

3733 Park E Dr
Suite 260
Beachwood, OH 44122-4337
Phone (216) 245-1290

Hospital & facility affiliations

  • South Pointe Hospital Hospital, Warrensville Heights, OH, CCN 360144
  • Summa Western Reserve Hospital Hospital, Cuyahoga Falls, OH, CCN 360150
  • Hillcrest Hospital Hospital, Mayfield Heights, OH, CCN 360230

Merit-based Incentive Payment System (MIPS)

Final score
94.53 of 100Reported as group
Quality
83.79
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue71
Removal of skin lesions1-10
Removal of nail tissue717
Removal or shaving of skin growth103

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36003762OHMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Podiatry Inc Podiatrist CurrentSince Jul 12, 2016 Accepting new patients
Podiatry Inc Podiatrist CurrentSince Jul 12, 2016 Accepting new patients

Locations

3733 Park East Dr
Ste 260
Beachwood, OH 44122

3733 Park East Dr
Ste 240
Beachwood, OH 44122
Phone (216) 378-2905

1236 Som Center Rd
Mayfield Heights, OH 44124
Phone (440) 681-2220

8382 Mentor Ave
Mentor, OH 44060

116 East Ave
Ste 4
Tallmadge, OH 44278
Phone (330) 310-6938

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1366588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467849600000",
    "number": "1043654007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3733 PARK EAST DR",
            "address_2": "SUITE 240",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224338",
            "telephone_number": "216-672-4330",
            "fax_number": "866-571-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 EAST AVE",
            "address_2": "SUITE 4",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442782300",
            "telephone_number": "216-245-1290",
            "fax_number": "866-571-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELTY",
        "first_name": "JASON",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-22",
        "last_updated": "2016-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36003762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallmadge, OH

Sources for this page

Verify at the official NPI Registry.