Michael John Kelly, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

26546 Issued in WA

Practice address

9040 Jackson Ave
Tacoma, WA 98431-1303

Phone

(253) 982-7084

NPI assigned

Jan 25, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in WA

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

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.

• Integrity Hearing Services, PS

  • Hearing and Speech Clinic/Center
  • Lakewood, WA
  • NPI 1891967071
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1093785586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-982-7084",
            "fax_number": "253-968-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984311303",
            "telephone_number": "253-982-7084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "690 Barnes Blvd",
            "address_purpose": "LOCATION",
            "city": "Joint Base Lewis McChord",
            "state": "WA",
            "postal_code": "984381303",
            "country_code": "US",
            "telephone_number": "253-982-7084",
            "fax_number": "253-968-3278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "26546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "930712715",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Kelly, MSW, LMSW
• Jessica Ellen Kelly, ARNP
• Katherine Jane Kelly, PH.D.
• Kendra Dane Kelly
• Khadine Kelly
• Michael Joseph Kelly, M.D.
• Ryan Kelly, DO
• Sean Kelly, D.D.S.
• Stephen Kelly, PA-C
• Tawny Kelly

• Family Medicine Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.