NPIMap

Individual provider Active NPI

Jennifer J Kelly, DO

  • Endocrinology, Diabetes & Metabolism Physician
  • South Burlington, VT
National Provider Identifier
1104867779
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
032.0129312 Issued in VT
Practice address
62 Tilley Dr Ste 202
South Burlington, VT 05403-4407
Phone
(802) 847-4576
Fax
(802) 847-4967
NPI assigned
Jun 8, 2006
Last updated
Aug 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 216420 NY
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 032.0129312 VT Primary

Addresses

Primary practice location

62 Tilley Dr Ste 202
South Burlington, VT 05403-4407

Mailing address

62 Tilley Dr Ste 202
South Burlington, VT 05403-4407
Phone (802) 847-4576

Other practice location 1

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Other practice location 2

133 Park St
Malone, NY 12953-1244
Phone (518) 481-2677

Other practice location 3

130 Fisher Rd Unit 1
Berlin, VT 05602-8132
Phone (802) 371-4100

Other identifiers 1

IdentifierTypeStateIssuer
02532745MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, VT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040708000609 NY Practitioner - Endocrinology 0042298952 Reassigns benefits to 2 organizations
I20170915002671 VT Practitioner - Internal MedicinePractitioner - Endocrinology 0042298952 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Endocrinology
Education
New York College of Osteo Medicine of New York Institute of Technology, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
032.0129312VTMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Vermont Medical Center Inc Endocrinology, Diabetes & Metabolism CurrentSince Aug 1, 2025 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Champlain Valley Physicians Hospital Medical Center CurrentSince Dec 4, 2023 Accepting new patients
Alice Hyde Medical Center Endocrinology, Diabetes & Metabolism CurrentSince Dec 4, 2023 Accepting new patients
University of Vermont Medical Center Inc CurrentSince Jun 1, 2017 Accepting new patients
Alice Hyde Medical Center Past Accepting new patients
Fletcher Allen Health Care Inc Past Accepting new patients

Locations

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

130 Fisher Rd
Unit 1
Berlin, VT 05602
Phone (802) 225-1743

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

62 Tilley Dr
Ste 202
South Burlington, VT 05403
Phone (802) 847-4576

Interoperability endpoints

  • Direct secure messaging: jkelly176496@direct.uvmhealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1104867779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 TILLEY DR STE 202",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054034407",
            "telephone_number": "802-847-4576",
            "fax_number": "802-847-4967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 TILLEY DR STE 202",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054034407",
            "telephone_number": "802-847-4576",
            "fax_number": "802-847-4967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Colchester Ave",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "VT",
            "postal_code": "054011473",
            "country_code": "US",
            "telephone_number": "802-847-0000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "133 Park St",
            "address_purpose": "LOCATION",
            "city": "Malone",
            "state": "NY",
            "postal_code": "129531244",
            "country_code": "US",
            "telephone_number": "518-481-2677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Fisher Rd Unit 1",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "VT",
            "postal_code": "056028132",
            "country_code": "US",
            "telephone_number": "802-371-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JENNIFER",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": "216420",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "VT",
            "license": "032.0129312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02532745",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

Verify at the official NPI Registry.