Zane Penton Kelly, CRNP
Individual provider Active NPI Family Medicine Physician · Tallassee, AL
NPI 1043787526 · NPPES record last updated Jul 14, 2021
Key facts
- NPI
- 1043787526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1-134397 (AL)
- Practice address
- 115 Herren Hill Rd
Tallassee, AL 36078-1276 - Phone
- (334) 283-3477
- Fax
- (334) 283-4162
- NPI assigned
- Nov 1, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Hospital Inc
John K.L. Porter, D.O., PC
Practice addresses (Care Compare)
115 Herren Hill Rd
Tallassee, AL 36078-1276
Phone (334) 283-3477
4749 Berry Blvd
Montgomery, AL 36106-3079
Phone (334) 579-3498
Hospital & facility affiliations
- Community Hospital Inc
- Jackson Hospital & Clinic Inc
- Elmore Community Hospital
- Baptist Medical Center South
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181206001525 | AL | Practitioner - Nurse Practitioner | 5395089064 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-134397 | AL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Hospital Inc | Current | Accepting new patients | |
| Regional Healthcare Group LLC | Current |
Accepting new patients | |
| Guardian Biologics LLC | Current |
Accepting new patients | |
| Community Hospital, Inc | Family Medicine | Current |
Accepting new patients |
| Community Hospital Inc | Family Medicine | Current |
Accepting new patients |
| Community Hospital | Past | Accepting new patients |
Locations
115 Herren Hill Rd
Tallassee, AL 36078
Phone (334) 246-4774
115 Herren Hill Rd
Ste C
Tallassee, AL 36078
Phone (334) 283-3477
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/commal-d9d80e4d
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1-134397 | AL | Yes |
Addresses
Primary practice location
115 Herren Hill Rd
Tallassee, AL 36078-1276
Mailing address
115 Herren Hill Rd
Tallassee, AL 36078-1276
Phone (334) 283-3477
Other providers in Tallassee, AL
- Jerkins Inc
- Jerkins Inc
- John S Rose DMD PC
- Collin Jones
- Shawn Keahey
- Diana L Kenyon
- Mary Kate Lackey
- Donna Lindsey
- Morgan Brantley Lock
- Suzanne M Lynch
All providers in Tallassee, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.