Charles Kelly, D.O.
Individual provider Active NPI Family Medicine Physician · Fulton, MS
NPI 1104895267 · NPPES record last updated Mar 8, 2011
Key facts
- NPI
- 1104895267
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 15058 (MS)
- Practice address
- 1 Medical Park Dr
Fulton, MS 38843-9001 - Phone
- (662) 862-5200
- Fax
- (662) 862-5297
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- West Virginia School of Osteopathic Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Mississippi Medical Clinics Inc
Practice addresses (Care Compare)
1 Medical Park Dr
Fulton, MS 38843-9001
Phone (662) 862-5200
Hospital & facility affiliations
- North Mississippi Medical Ctr HHA
- Centerwell Home Health
- North Mississippi Medical Ctr
- North Mississippi Medical Center
- North Mississippi Medical Center-Gilmore Amory
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 59 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 13 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100510000332 | MS | Practitioner - Family Practice | 2163550377 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Mississippi Medical Center | Current | Accepting new patients | |
| North Mississippi Medical Clinics Inc | Current |
Accepting new patients | |
| North Mississippi Medical Clinics Inc | Family Medicine | Current |
Accepting new patients |
Locations
1 Medical Park Dr
Fulton, MS 38843
Phone (662) 862-5200
845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025
Interoperability endpoints
- charleskelly@nmhs.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15058 | MS | Yes |
Addresses
Primary practice location
1 Medical Park Dr
Fulton, MS 38843-9001
Mailing address
1 Medical Park Dr
Fulton, MS 38843-9001
Phone (662) 862-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00117294 | Medicaid | MS |
Other providers in Fulton, MS
- Kaitlin Holley
- Hometown Healthcare Inc
- Michael George Howell
- HSR Corp
- Amanda Jody Johnson-Kelly
- Magean Lashae Kemp
- Benton Ernest Kilman
- Gerald E. Klein
- Summer Dawn Lesley
- Mantachie Rural Health Care, Inc
All providers in Fulton, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.