Theodore M. Kelley, MD
Individual provider Active NPI Family Medicine Physician · Locust, NC
NPI 1154520823 · NPPES record last updated Jul 15, 2024
Key facts
- NPI
- 1154520823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2009-00823 (NC)
- Practice address
- 123 Professional Park Dr
Locust, NC 28097-7712 - Phone
- (704) 403-6760
- NPI assigned
- Jul 13, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Tennessee, HSC, College of Medicine, 2007
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Carolinas Physicians Network Inc
Carolina Physical Therapy Associates LLC
Comprehab, Inc
Practice addresses (Care Compare)
123 Professional Park Dr
Locust, NC 28097-7712
Phone (704) 403-6760
12925 Hwy 601
Suite 300
Midland, NC 28107-9536
Phone (704) 888-3702
236 Lephillip Court
Suite a
Concord, NC 28025-1917
Phone (419) 221-6717
2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800
Hospital & facility affiliations
- Atrium Healt at Home Stanly
- Bayada Home Health Care Inc
- Gentiva Health Services/Salisb
- Carolinas Medical Center/Behav Health
- Carolinas Medical Center-Northeast
- Stanly Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94 of 100
- Quality
- 81.63
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20100714000462 | NC | Practitioner - Family Practice | 9335271139 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009-00823 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Physicians Network Inc | Current |
Accepting new patients | |
| Carolinas Physicians Network Inc | Current | Accepting new patients | |
| The Charlotte-Mecklenburg Hospital Authority | Current | Accepting new patients | |
| Carolinas Physicians Network Inc | Family Medicine | Current |
Accepting new patients |
| The Charlotte-Mecklenburg Hospital Authority | Family Medicine | Current |
Accepting new patients |
| Carolinas Physicians Network Inc | Current | Accepting new patients | |
| Carolinas Physicians Network Inc | Family Medicine | Current |
Accepting new patients |
| Carolinas Physicians Network, Inc | Family Medicine | Past | Accepting new patients |
Locations
100 N 6th St
Ste 900A
Minneapolis, MN 55403
14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650
14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070
920 Church St N
Concord, NC 28025
Phone (704) 403-3000
270 Copperfield Blvd NE
Ste 102
Concord, NC 28025
Phone (704) 721-2060
123 Professional Park Dr
Locust, NC 28097
Phone (704) 403-6760
12925 Highway 601
Ste 300
Midland, NC 28107
Phone (704) 258-2444
8560 Cook St
Mt Pleasant, NC 28124
Phone (704) 403-1911
Interoperability endpoints
- tkelley128929@carolinashealthcaresystem.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2009-00823 | NC | Yes |
Addresses
Primary practice location
123 Professional Park Dr
Locust, NC 28097-7712
Mailing address
PO Box 19305
Charlotte, NC 28219-9305
Other practice location 1
12925 Highway 601
Ste 300
Midland, NC 28107-9535
Phone (704) 888-3702
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tkelley128929@CarolinasHealthcareSystem.direct-ci.com | Atrium Health | |
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
Other providers in Locust, NC
- Humbled Hands Transportation Services LLC
- Impact Global Services Inc
- Inner Shalom, PLLC
- Insync Labs and Solutions LLC
- Brittany Kamholtz
- Lisa Kiker
- Lori Kodikara
- Ngoc Le
- Rachel Long
- Steven Edward Lucas
All providers in Locust, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2024. 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.