NPIMap

Individual provider Active NPI

David Kelly, MD

  • Specialist
  • Plymouth, MA
National Provider Identifier
1184618910
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
224721 Issued in MA
Practice address
275 Sandwich St
Plymouth, MA 02360-2183
Phone
(508) 830-2121
NPI assigned
Sep 8, 2005
Last updated
Sep 22, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 224721 MA Primary

Addresses

Primary practice location

275 Sandwich St
Plymouth, MA 02360-2183

Mailing address

PO Box 1260
Att: Denise Costa
Plymouth, MA 02362-1260
Phone (774) 454-8868

Other identifiers 1

IdentifierTypeStateIssuer
2104253MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050728000928 MA Practitioner - Diagnostic Radiology 6204809817 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Virginia School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians of Cape Cod HospitalGroup PAC ID 9638326671, 330 clinicians

Practice addresses (Care Compare)

27 Park St
Hyannis, MA 02601-5230
Phone (774) 552-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
224721MAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Cod Pet/CT Services, LLC CurrentSince Jan 16, 2025 Accepting new patients
Jordan Physician Associates, Inc. CurrentSince Aug 5, 2022 Accepting new patients
Physicians of Cape Cod Hospital CurrentSince Dec 6, 2021 Accepting new patients
New York University Medical Center Faculty Practice Radiology Past Accepting new patients
Commonwealth Radiology Associates, Inc Specialist Past Accepting new patients
MRI Radiologists of the N Shore Inc Past Accepting new patients
Nyumc Radiology Associates Past Accepting new patients

Locations

100 Ter Heun Dr
Falmouth, MA 02540
Phone (508) 457-3501

27 Park St
Hyannis, MA 02601
Phone (508) 775-5011

199 Reedsdale Rd
Milton, MA 02186
Phone (617) 313-1000

275 Sandwich St
Plymouth, MA 02360
Phone (508) 746-2000

46 Obery St
Plymouth, MA 02360
Phone (508) 210-5920

Interoperability endpoints

  • Direct secure messaging: dkelly255240@direct.bilh.masshiway.net

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beth Israel Deaconess Hospital Plymouth IncPlymouth, MA, CCN 220060 Hospital Corporate Director Jan 1, 2019
Beth Israel Deaconess Hospital Plymouth IncPlymouth, MA, CCN 22S060 Hospital Corporate Director Jan 1, 2019
Cranberry HospicePlymouth, MA, CCN 221520B Hospice Corporate Director Jan 1, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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 2

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1184618910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1260",
            "address_2": "ATT: DENISE COSTA",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023621260",
            "telephone_number": "774-454-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-830-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MA",
            "license": "224721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2104253",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

Verify at the official NPI Registry.