NPIMap

Organization Active NPI

Jon P. Kelly, M.D., a Medical Corporation

  • Specialist
  • Escondido, CA
National Provider Identifier
1184804999
Registry record updated Nov 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A45013 Issued in CA
Legal business name
JON P. KELLY, M.D., A MEDICAL CORPORATION
Practice address
255 N Elm St
Suite 105
Escondido, CA 92025-3431
Phone
(760) 743-0100
Fax
(760) 743-1414
NPI assigned
Nov 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2007

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

Authorized official

Name
Jon Pembroke Kelly, M.D.
Title
Owner/President
Phone
(760) 743-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A45013 CA Primary

Addresses

Primary practice location

255 N Elm St
Suite 105
Escondido, CA 92025-3431

Mailing address

255 N Elm St
Suite 105
Escondido, CA 92025-3431
Phone (760) 743-0100

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1184804999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N ELM ST",
            "address_2": "SUITE 105",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253431",
            "telephone_number": "760-743-0100",
            "fax_number": "760-743-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N ELM ST",
            "address_2": "SUITE 105",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253431",
            "telephone_number": "760-743-0100",
            "fax_number": "760-743-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON P. KELLY, M.D., A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "PEMBROKE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "760-743-0100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A45013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.