Individual provider Active NPI

Kelly Andre Jarrett, M.D.

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1124339080
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
281898 Issued in NY
Practice address
455 Sutter Ave
Brooklyn, NY 11212-8111
Phone
(718) 765-6550
Fax
(347) 620-9739
NPI assigned
Jun 25, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Preventive Medicine) Physician 2083A0300X 281898 NY
Hospitalist Physician 208M00000X 281898 NY
Family Medicine Physician 207Q00000X 281898 NY Primary

Addresses

Primary practice location

455 Sutter Ave
Brooklyn, NY 11212-8111

Mailing address

PO Box 746087
Atlanta, GA 30374-6087
Phone (312) 733-9730

Other practice location 1

2006 Madison Ave
New York, NY 10035-1217
Phone (212) 633-0815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20160303000208 NY Practitioner - Family Practice 6507162468 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Miami, LM Miller School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Griffin Myers Medical PCGroup PAC ID 5294145017, 78 clinicians

Practice addresses (Care Compare)

455 Sutter Ave
Brooklyn, NY 11212-8111
Phone (718) 765-6550

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
281898NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Start Treatment & Recovery Centers Inc Current Accepting new patients
Quickmed Medical P.C. CurrentSince Jul 1, 2016 Accepting new patients
Startcare, Inc. CurrentSince Dec 3, 2018 Accepting new patients
Griffin Myers Medical, P.C. Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Startcare, Inc. CurrentSince Dec 3, 2018 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Jun 11, 2019 Accepting new patients

Locations

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

455 Sutter Ave
Brooklyn, NY 11212
Phone (718) 765-6550

494 Dumont Ave
Brooklyn, NY 11207
Phone (718) 260-2920

937 Fulton St
Brooklyn, NY 11238
Phone (718) 260-2900

11515 Sutphin Blvd
Jamaica, NY 11434
Phone (718) 659-4000

46 Main St
Ste 148
Monsey, NY 10952
Phone (917) 740-3853

2689 Broadway
New York, NY 10025
Phone (212) 832-2756

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1124339080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746087",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746087",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 SUTTER AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112128111",
            "telephone_number": "718-765-6550",
            "fax_number": "347-620-9739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2006 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100351217",
            "country_code": "US",
            "telephone_number": "212-633-0815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JARRETT",
        "first_name": "KELLY",
        "middle_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "NY",
            "license": "281898",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "281898",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "281898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.