Kelly Dean Skanchy, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

GFE83510 Issued in CA

Practice address

2450 Craven St BLDG 3300
Naval Health Clinic Naval Station San Diego
San Diego, CA 92136-5599

Phone

(619) 556-5936

Fax

(619) 556-9419

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• NMC San Diego

  • Military/U.S. Coast Guard Pharmacy
  • San Diego, CA
  • NPI 1124125984
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1154313971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 CRAVEN ST BLDG 3300",
            "address_2": "NAVAL HEALTH CLINIC NAVAL BASE SAN DIEGO",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365599",
            "telephone_number": "619-556-5936",
            "fax_number": "619-556-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 CRAVEN ST BLDG 3300",
            "address_2": "NAVAL HEALTH CLINIC NAVAL STATION SAN DIEGO",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365599",
            "telephone_number": "619-556-5936",
            "fax_number": "619-556-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKANCHY",
        "first_name": "KELLY",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "MD044935L",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "GFE83510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Stanley Skaggs III, IDC
• Jordyn Skaggs
• Stanley Dean Skaggs, MD
• Heather Leigh Lyons Skalak, DPT, PT
• Andrew J Skalsky, M.D.
• Kira A. Skavinski, D.O.
• Jennifer Renee Skeen
• Douglas Wayne Skelly-Brown III, LMFT
• Jacob Skelly-Brown, MFT
• Dana Skelly

• Sports Medicine (Family Medicine) Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Sports Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.