NPIMap

Individual provider Active NPI

Carmel M Kelly, MD

  • Family Medicine Physician
  • Randolph, MA
National Provider Identifier
1164416228
Registry record updated Apr 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
57521 Issued in MA
Practice address
1093 N Main St
Randolph, MA 02368-2100
Phone
(781) 963-0676
Fax
(781) 963-7417
NPI assigned
Sep 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2011

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 57521 MA Primary

Addresses

Primary practice location

1093 N Main St
Randolph, MA 02368-2100

Mailing address

1093 N Main St
Randolph, MA 02368-2100
Phone (781) 963-0676

Other identifiers 15

IdentifierTypeStateIssuer
0100052OtherEVERCARE
0100918OtherNEUNITED HLTHCARE OF NE
3567516OtherAETNA HEALTH PLAN
043243146OtherUNICARE
21003084366OtherBEECH STREET
J06362OtherBLUE CARE ELECT
M15986OtherBLUE CROSS INDEMNITY
7134757002OtherCIGNA
J06362OtherHMO BLUE
043243146OtherHCVM
043243146OtherGREAT WEST HEALTHCARE
64506OtherHARVARD PILGRIM
043243146OtherHARVARD PILGRIM
3022447MedicaidMA
J06362OtherBLUE CROSS INDEMNITY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050406001046 MA Practitioner - Family PracticePractitioner - Geriatric Medicine 4789631284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1093 N Main St
Randolph, MA 02368-2100
Phone (781) 963-0676

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57521MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians Associates, Inc. Family Medicine CurrentSince May 1, 1987 Accepting new patients
Community Physicians Associates, Inc. CurrentSince May 1, 1987 Accepting new patients
Community Physicians Associates, Inc. Past Accepting new patients

Locations

1093 N Main St
Randolph, MA 02368
Phone (781) 963-0676

Interoperability endpoints

  • Direct secure messaging: ckelly447834@direct.bilh.masshiway.net
  • Direct secure messaging: carmel.kelly@cpa.eclinicaldirectplus.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302134400000",
    "number": "1164416228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682100",
            "telephone_number": "781-963-0676",
            "fax_number": "781-963-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682100",
            "telephone_number": "781-963-0676",
            "fax_number": "781-963-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CARMEL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2011-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "57521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0100052",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HLTHCARE OF NE",
            "identifier": "0100918",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH PLAN",
            "identifier": "3567516",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "043243146",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH STREET",
            "identifier": "21003084366",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE ELECT",
            "identifier": "J06362",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INDEMNITY",
            "identifier": "M15986",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7134757002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO BLUE",
            "identifier": "J06362",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCVM",
            "identifier": "043243146",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST HEALTHCARE",
            "identifier": "043243146",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "64506",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "043243146",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3022447",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INDEMNITY",
            "identifier": "J06362",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

Verify at the official NPI Registry.