Mary Alice Kelly, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1568631 Issued in NY

Practice address

1900 Ridge Rd
Ste 130
West Seneca, NY 14224-3332

Phone

(716) 675-0707

Fax

(716) 961-3706

NPI assigned

May 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

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

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 and National Provider Directory roles.

• Trinity Medical Wny PC

  • Internal Medicine Physician
  • Buffalo, NY
  • NPI 1295043149
  Medicare reassignment NPD
• Trinity Medical Wny PC

  • Orthopaedic Surgery Physician
  • Williamsville, NY
  • NPI 1144878893

  Internal Medicine

  NPD
• Trinity Medical Wny PC

  • Vascular Surgery Physician
  • Buffalo, NY
  • NPI 1205468055
  NPD

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350604800000",
    "number": "1053361816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RIDGE RD",
            "address_2": "STE130",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243332",
            "telephone_number": "716-675-0707",
            "fax_number": "716-961-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 RIDGE RD",
            "address_2": "STE 130",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243332",
            "telephone_number": "716-675-0707",
            "fax_number": "716-961-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2012-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1568631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "0401537",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010089201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000500738001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie Kellner, RPH
• Kelly a. Hauser, RN
• Joshua Matthew Kelly, PHARMD
• Kara Danielle Kelly, M.A., CCC-SLP
• Mallory Lynn Kelly, RPA-C
• Michael H Kelly, L.M.T.
• Thomas Paul Kenjarski, DDS
• Alison Kern
• Pamela Sue Kessler
• Mahnoor Khan

• Internal Medicine Physician in West Seneca, NY
• Providers in West Seneca, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.