Manuel R Kelley, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C-5328 Issued in AR

Practice address

1101 Tennessee St
Pine Bluff, AR 71601-5801

Phone

(870) 543-2380

Fax

(870) 535-4716

NPI assigned

Apr 21, 2006

Last updated

Sep 29, 2010By the provider in NPPES

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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Family Practice

Education

University of Colorado School of Medicine, Denver, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Comprehensive Care System, IncGroup PAC ID 5193634509, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jefferson Comprehensive Care System, Inc

  • Federally Qualified Health Center (FQHC)
  • Pine Bluff, AR
  • NPI 1154386597
  Medicare reassignment Care Compare group
• Jefferson Comprehensive Care System, Inc

  dba Opeh Hands Center

  • Federally Qualified Health Center (FQHC)
  • Little Rock, AR
  • NPI 1689870065
  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1083670830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1285",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131285",
            "telephone_number": "870-543-2380",
            "fax_number": "870-535-4716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 TENNESSEE ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716015801",
            "telephone_number": "870-543-2380",
            "fax_number": "870-535-4716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MANUEL",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C-5328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "52821",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103173001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C68619",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0120403",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "1159400000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muhammad Ahmer Kashif, M.D.
• Daniel Adane Kassa, MD
• Katherine's Little Angels Adult Care Center
• Decontee Berniece Kaye, MD
• KB's Adult Health Day Care Center
• Abesie Kelly, PHD
• Jerricka Kelly, B.S.
• Kenneth Carswell, LLC
• Marie Antoinette Kent, M.D.
• Kforney

• Family Medicine Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.