Active NPI
Lester Kelty, MD
- Emergency Medicine Physician
- Rock Island, IL
National Provider Identifier
1053371989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 036056379
- Practice address
- 2701 17TH St
Rock Island, IL 61201-5351 - Phone
- (309) 779-5000
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036056379 | IL | Primary |
Addresses
Primary practice location
2701 17TH St
Rock Island, IL 61201-5351
Mailing address
2701 17TH St
Rock Island, IL 61201-5351
Phone (309) 779-5000
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036056379 | Other | BCILLINIOS | |
| 2927525 | Medicaid | IA | |
| 1927525 | Medicaid | IA | |
| 91481 | Other | BCWELLMARK 7TH | |
| 143400 | Other | IHS | |
| 93361 | Other | BCWELLMARK WEST | |
| IL0181 | Other | JOHN DEERE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036056379 | IL | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1053371989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 17TH ST",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612015351",
"telephone_number": "309-779-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 17TH ST",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612015351",
"telephone_number": "309-779-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELTY",
"first_name": "LESTER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036056379",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCILLINIOS",
"identifier": "036056379",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2927525",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1927525",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCWELLMARK 7TH",
"identifier": "91481",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHS",
"identifier": "143400",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCWELLMARK WEST",
"identifier": "93361",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "IL0181",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Rock Island, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.