NPIMap

Individual provider Active NPI

Sean R Kelly, DO

  • Internal Medicine Physician
  • Washington, PA
National Provider Identifier
1174592760
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS012378 Issued in PA
Practice address
151 N Franklin St
Washington, PA 15301-4378
Phone
(724) 222-7240
NPI assigned
Mar 16, 2006
Last updated
Jul 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS012378 PA Primary

Addresses

Primary practice location

151 N Franklin St
Washington, PA 15301-4378

Mailing address

701 Technology Dr Ste 150
Canonsburg, PA 15317-9531
Phone (412) 531-2902

Other identifiers 2

IdentifierTypeStateIssuer
1012265060001MedicaidPA
1688548OtherPAHIGHMARK BS/ KHPW

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20050406000632 PA Practitioner - Internal Medicine 7113974650 Reassigns benefits to 1 organization
Practice locations: Washington, PA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

151 N Franklin St
Washington, PA 15301-4378
Phone (724) 222-7240

2375 Greentree Rd
Carnegie, PA 15106-4203
Phone (412) 276-1560

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Preferred Primary Care Physicians, Inc. Internal Medicine CurrentSince Feb 1, 2015 Accepting new patients
Preferred Primary Care Physicians, Inc. Internal Medicine Current Accepting new patients
Preferred Primary Care Physicians CurrentSince Feb 1, 2015 Accepting new patients
Assisted Living at Evergreen, Inc. Past Accepting new patients
The Cherrytree Personal Care Inc Past Accepting new patients

Locations

701 Technology Dr
Ste 150
Canonsburg, PA 15317
Phone (412) 531-2902

2375 Greentree Rd
Carnegie, PA 15106
Phone (412) 276-1560

1910 Cochran Rd
Ste 490
Pittsburgh, PA 15220

151 N Franklin St
Washington, PA 15301
Phone (412) 222-7240

Interoperability endpoints

  • Direct secure messaging: seankellydo@preferred.medentdirect.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1174592760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TECHNOLOGY DR STE 150",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153179531",
            "telephone_number": "412-531-2902",
            "fax_number": "412-531-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N FRANKLIN ST",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153014378",
            "telephone_number": "724-222-7240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SEAN",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS012378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012265060001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS/ KHPW",
            "identifier": "1688548",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, PA

Sources for this page

Verify at the official NPI Registry.