Charles M. Kelly II, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

67391 Issued in MN

Practice address

1705 N Highway 20
Cannon Falls, MN 55009-1187

Phone

(507) 263-4900

NPI assigned

Apr 3, 2017

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 names 1

• C. Michael Kelly II Other name

Medicare fee-for-service enrollment

Enrolled in MN

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 Nebraska College of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olmsted Medical CenterGroup PAC ID 8527970060, 324 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adara Home Health Inc Home health agency, Buffalo, MN, CCN 248056
• Olmsted Medical Center Hospital, Rochester, MN, CCN 240006
• Mayo Clinic Health System - Cannon Falls Hospital, Cannon Falls, MN, CCN 241346
• Northfield Hospital Hospital, Northfield, MN, CCN 240014
• Mayo Clinic Health System in Red Wing Hospital, Red Wing, MN, CCN 240018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckelly17555@direct.olmmed.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.

• Olmsted Medical Center

  • Clinic/Center
  • Rochester, MN
  • NPI 1952356297
  Medicare reassignment Care Compare group NPD

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

• Mayo Clinic Health System-Southeast Minnesota Region

  • General Acute Care Hospital
  • Red Wing, MN
  • NPI 1164400024
  Care Compare affiliation Name & address match
• Adara Home Health, Inc.

  • Home Health Agency
  • Buffalo, MN
  • NPI 1063420198
  Care Compare affiliation
• Mayo Clinic Health System-Southeast Minnesota Region

  • Critical Access Hospital
  • Cannon Falls, MN
  • NPI 1063435410
  Care Compare affiliation
• Northfield Hospital

  • Rural Acute Care Hospital
  • Northfield, MN
  • NPI 1417990805
  Care Compare affiliation

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1093247447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 N HIGHWAY 20",
            "city": "CANNON FALLS",
            "state": "MN",
            "postal_code": "550091187",
            "telephone_number": "507-263-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 N HIGHWAY 20",
            "city": "CANNON FALLS",
            "state": "MN",
            "postal_code": "550091187",
            "telephone_number": "507-263-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHARLES",
        "middle_name": "M.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-03",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "67391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C.",
            "last_name": "KELLY",
            "middle_name": "MICHAEL",
            "suffix": "II",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lisa Lynn Hynes, PHARMD
• John E Holte OD
• Shaunna K Johnson, OT
• Megan Susan Johnston Flanders, MD
• Mark J Juetten, DDS
• Kerry K Brown PSYD LP PLC
• Eric Ray Leveille, MD
• Libra Support Services LLC
• Leah Lindbeck, CNP-APRN
• Matthew August Maki, D.C.

• Family Medicine Physician in Cannon Falls, MN
• Providers in Cannon Falls, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.