NPIMap

Individual provider Active NPI

Mark Humphreys Kelly, MD

  • Diagnostic Radiology Physician
  • Wilmington, NC
National Provider Identifier
1174027320
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2023-01135 Issued in NC
Practice address
1025 Medical Center Dr
Wilmington, NC 28401-7354
Phone
(910) 762-3882
NPI assigned
Mar 22, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 2023-01135 NC Primary

Addresses

Primary practice location

1025 Medical Center Dr
Wilmington, NC 28401-7354

Mailing address

PO Box 63233
Charlotte, NC 28263-3233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240724002529 NC Practitioner - Diagnostic Radiology 9234480617 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Duke University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaney Radiologists Group PLLCGroup PAC ID 4981684875, 55 clinicians
Delaney Radiologists PAGroup PAC ID 6305813684, 55 clinicians

Practice addresses (Care Compare)

1025 Medical Ctr Dr
Wilmington, NC 28401-7354
Phone (910) 762-3882

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141
  • Novant Health Brunswick Medical Center Hospital, Supply, NC, CCN 340158
  • J Arthur Dosher Memorial Hospital Hospital, Southport, NC, CCN 341327
  • Onslow Memorial Hospital Hospital, Jacksonville, NC, CCN 340042
  • Pender Memorial Hospital Hospital, Burgaw, NC, CCN 341307

Merit-based Incentive Payment System (MIPS)

Final score
83.57 of 100Reported as group
Quality
80.67
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.72 of 100Reported as group
Quality
88.57
Improvement activities
40
Cost
60.01

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023-01135NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington ASC LLC CurrentSince Aug 1, 2024 Accepting new patients
Delaney Radiologists Group PLLC CurrentSince Aug 1, 2024 Accepting new patients
Delaney Radiologists PA CurrentSince Aug 1, 2024 Accepting new patients
Wilmington Health PLLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

1025 Medical Center Dr
Wilmington, NC 28401
Phone (910) 762-3882

2800 Ashton Dr
Ste 102
Wilmington, NC 28412
Phone (910) 762-3882

1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705

Organizations & group practices 4

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 10

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": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1174027320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63233",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017354",
            "telephone_number": "910-762-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARK",
        "middle_name": "HUMPHREYS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-22",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2023-01135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.