James Patrick Kelly, MD, MBA

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

1034778A Issued in IN

Practice address

17022 Shandwick Lane
Granger, IN 46530

Phone

(574) 277-9156

Fax

(574) 271-5639

NPI assigned

Oct 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

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.

• Cardiothoracic Surgery, P.C.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • South Bend, IN
  • NPI 1457536336
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1174608442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17022 SHANDWICK LANE",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "46530",
            "telephone_number": "574-277-9156",
            "fax_number": "574-271-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17022 SHANDWICK LANE",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "46530",
            "telephone_number": "574-277-9156",
            "fax_number": "574-271-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JAMES",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "MD, MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01034778",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "1034778A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100193010A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin P Kaufhold, MD
• Shanna Verma Kautzmann, M.D.
• Hasaan Amer Kazi, MD
• Anna Keller, RBT
• Sharon Donnelly Keller, M.S., L.C.P.C.
• Amy R. Kendall, OTR
• Michele Renae Kenney
• Lori Lynn Kerr
• Natalie Kilheeney, L.AC., DIPL. O.M.
• Jenna Michele Kimminau, LSW

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Granger, IN
• Providers in Granger, IN by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.