NPIMap

Individual provider Active NPI

Alla Kelly, MD

  • Ophthalmology Physician
  • Woodbury, MN
National Provider Identifier
1174750079
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
56347 Issued in MN
Practice address
2080 Woodwinds Dr
110
Woodbury, MN 55125-2523
Phone
(651) 738-6800
Fax
(651) 714-6997
NPI assigned
Jun 18, 2009
Last updated
Aug 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 56347 MN Primary

Addresses

Primary practice location

2080 Woodwinds Dr
110
Woodbury, MN 55125-2523

Mailing address

2080 Woodwinds Dr
110
Woodbury, MN 55125-2523
Phone (651) 738-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20130627000566 MN Practitioner - Ophthalmology 3375783160 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Wayne State University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Paul Eye Clinic PAGroup PAC ID 6709773823, 20 clinicians

Practice addresses (Care Compare)

1093 Grand Ave
St Paul, MN 55105-3002
Phone (651) 227-6634

1215 Town Centre Dr
Suite 100
Eagan, MN 55123-1356
Phone (651) 454-2526

1675 Beam Ave
Suite 100
Maplewood, MN 55109-1478
Phone (651) 770-2904

2080 Woodwinds Dr
Suite 230
Woodbury, MN 55125-2539
Phone (651) 578-6949

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.92 of 100Reported as group
Quality
89.37
Promoting interoperability
100
Improvement activities
40
Cost
73.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery148

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Jun 7, 2013 Accepting new patients
St Paul Eye Clinic PA CurrentSince Aug 1, 2014 Accepting new patients
Fairview Health Services CurrentSince Jun 7, 2013 Accepting new patients
St Paul Eye Clinic PA CurrentSince Aug 1, 2014 Accepting new patients

Locations

1215 Town Centre Dr
Ste 100
Eagan, MN 55123
Phone (651) 454-2526

1675 Beam Ave
Ste 100
Maplewood, MN 55109
Phone (651) 227-6634

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

2680 Snelling Ave N
Ste 110
Roseville, MN 55113
Phone (651) 631-2922

1093 Grand Ave
Saint Paul, MN 55105
Phone (651) 222-7343

5945 Norwich Ave N
Stillwater, MN 55082
Phone (651) 351-2038

2080 Woodwinds Dr
Ste 110
Woodbury, MN 55125
Phone (651) 738-6500

2080 Woodwinds Dr
Ste 230
Woodbury, MN 55125
Phone (651) 578-6949

Organizations & group practices 6

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 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1174750079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 WOODWINDS DR",
            "address_2": "110",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252523",
            "telephone_number": "651-738-6800",
            "fax_number": "651-714-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 WOODWINDS DR",
            "address_2": "110",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252523",
            "telephone_number": "651-738-6800",
            "fax_number": "651-714-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ALLA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-18",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "56347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.