NPIMap

Organization Active NPI

Kelsey Prosthetics Orthotics LLC

  • Prosthetic/Orthotic Supplier
  • Greenfield, WI
National Provider Identifier
1164796496
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
KELSEY PROSTHETICS ORTHOTICS LLC
Practice address
6790 W Layton Ave
Greenfield, WI 53220-4571
Phone
(414) 282-3100
Fax
(414) 282-3101
NPI assigned
Mar 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Mr. Brian Kelsey, CPONPI 1083610604
Title
Owner
Phone
(414) 282-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X WI Primary

Addresses

Primary practice location

6790 W Layton Ave
Greenfield, WI 53220-4571

Mailing address

6790 W Layton Ave
Greenfield, WI 53220-4571
Phone (414) 282-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120521000514 WI DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 6901069426 Practice locations: Greenfield, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Kelsey Prosthetics Orthotics LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1164796496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6790 W LAYTON AVE",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204571",
            "telephone_number": "414-282-3100",
            "fax_number": "414-282-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6790 W LAYTON AVE",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204571",
            "telephone_number": "414-282-3100",
            "fax_number": "414-282-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELSEY PROSTHETICS ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-05",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "KELSEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-282-3100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.