Phillip Antonio Kelley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04383 Issued in NC

Practice address

390 W Salem Ave
Winston Salem, NC 27101-5861

Phone

(336) 721-2375

Fax

(336) 721-2394

NPI assigned

Jul 15, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations (25 of 29)

Interoperability endpoints

• Direct secure messaging: pkelley78310@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment Care Compare group
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment
• Forsyth Memorial Hospital, Inc.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Greensboro, NC
  • NPI 1508741067
  NPD
• Forsyth Memorial Hospital, Inc

  • Rheumatology Physician
  • Winston Salem, NC
  • NPI 1124571229
  NPD
• Forsyth Memorial Hospital, Inc.

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Greensboro, NC
  • NPI 1871149872
  NPD
• Novant Health Medical Group, LLC

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1134841802
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1083055396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 W SALEM AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271015861",
            "telephone_number": "336-721-2375",
            "fax_number": "336-721-2394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1904 Jake Alexander Blvd W Ste 301",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281471177",
            "country_code": "US",
            "telephone_number": "704-638-1551",
            "fax_number": "704-638-1553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "794 S Main St Ste B",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272844074",
            "country_code": "US",
            "telephone_number": "336-904-2317",
            "fax_number": "336-443-6030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2452 Fairlawn Ct",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063884",
            "country_code": "US",
            "telephone_number": "336-443-9910",
            "fax_number": "336-443-9909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1065",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1977 Cotton Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "NC",
            "postal_code": "272925721",
            "country_code": "US",
            "telephone_number": "336-243-3000",
            "fax_number": "336-243-3012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "PHILLIP",
        "middle_name": "ANTONIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkelley78310@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1904 Jake Alexander Blvd W Ste 301",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281471177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amber Brewer Keller, PA-C
• Calvin Woodrow Keller, LAT-ATC
• Jennifer Keller, FNP
• Tiffany Keller, NP
• Amber Smoot Kelley, LPC
• Chloe Kellogg, CRNP
• Kathleen Hartney Kellum, LPC, NCC
• Kelly-Scism LLC
• Allison Daley Kelly, NBC-HWC
• Amber Norris Kelly, RD

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.