John Thomas Kelly, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

036-077958 Issued in IL

Practice address

175 Blossom St Unit 1407
Boston, MA 02114-2629

Phone

(215) 527-4684

NPI assigned

Oct 31, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

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

{
    "created_epoch": "1256947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1164758892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 BLOSSOM ST UNIT 1407",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142629",
            "telephone_number": "215-527-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 BLOSSOM ST UNIT 1407",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142629",
            "telephone_number": "215-527-4684"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Brighton Ln",
            "address_purpose": "LOCATION",
            "city": "Oak Brook",
            "state": "IL",
            "postal_code": "605232324",
            "country_code": "US",
            "telephone_number": "215-527-4684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-31",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036-077958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane C Kelly
• Jayme Elizabeth Kelly
• Jean Kelly, D.C.
• Joan Marie Kelly, MSN, ANP
• John F Kelly, PHD
• Julia Ann Kelly, MD
• Julianne Mae Kelly, BS
• Kaitlynn Erin Kelly, PA-C
• Karen Elizabeth Kelly, M.D.
• Katelyn Kelly, LCSW

• General Practice Physician in Boston, MA
• Providers in Boston, MA by specialty
• General Practice Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.