NPIMap

Individual provider Active NPI

Stephen B. Kelly, M.D.

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1134167455
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21242 Issued in OK
Practice address
13921 N Meridian Ave Ste 100
Oklahoma City, OK 73134-1106
Phone
(405) 752-9600
Fax
(405) 752-9650
NPI assigned
Jun 2, 2006
Last updated
Apr 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 21242 OK Primary

Addresses

Primary practice location

13921 N Meridian Ave Ste 100
Oklahoma City, OK 73134-1106

Mailing address

PO Box 268938
Oklahoma City, OK 73126-8938
Phone (405) 752-9600

Other identifiers 2

IdentifierTypeStateIssuer
21242OtherOKSTATE MD LICENSE
100066450AMedicaidOK

Other names 1

  • S. Blake Kelly Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040710000376 OK Practitioner - Family PracticePractitioner - Pain Management 3476543794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Pain Management
Education
University of Oklahoma College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kelly Medical, PCGroup PAC ID 3173535515, 7 clinicians

Practice addresses (Care Compare)

13921 N Meridian Ave
Suite 100
Oklahoma City, OK 73134-1106
Phone (405) 752-9600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.6 of 100Reported as individual
Quality
95.2
Improvement activities
40
Cost
55.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21242OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kelly Medical, PC Family Medicine CurrentSince Dec 19, 2005 Accepting new patients
Toxicology Center LLC Current Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Great Plains Medical Foundation Family Medicine PastSince Jan 15, 2022 Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Health Network Inc Family Medicine Past Accepting new patients
Oklahoma Outpatient Pain and Spine Center LLC Past Accepting new patients

Locations

13921 N Meridian Ave
Ste 100
Oklahoma City, OK 73134
Phone (405) 749-0900

5101 W Memorial Rd
Oklahoma City, OK 73142
Phone (405) 463-5700

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1134167455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268938",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268938",
            "telephone_number": "405-752-9600",
            "fax_number": "405-752-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13921 N MERIDIAN AVE STE 100",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341106",
            "telephone_number": "405-752-9600",
            "fax_number": "405-752-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "STEPHEN",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "21242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MD LICENSE",
            "identifier": "21242",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100066450A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "S.",
            "last_name": "KELLY",
            "middle_name": "BLAKE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.