Active NPI
Adrienne Margaret Kelly, MD
- Orthopaedic Surgery of the Spine Physician
- Gaylord, MI
National Provider Identifier
1205189669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery of the Spine Physician
- License
- 4301101907
- Practice address
- 2147 Professional Dr
Gaylord, MI 49735-0003 - Phone
- (989) 732-1753
- Fax
- (989) 731-1425
- NPI assigned
- Oct 23, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Reconstructive Orthopaedic Surgery Physician | 207XS0114X | 4301101907 | MI | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | 4301101907 | MI | Primary |
| Orthopaedic Trauma Physician | 207XX0801X | 4301101907 | MI |
Addresses
Primary practice location
2147 Professional Dr
Gaylord, MI 49735-0003
Mailing address
829 N Center Ave
Suite 298
Gaylord, MI 49735-1595
Phone (989) 731-7708
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OF96004 | Other | MEDICARE GROUP NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Petoskey Surgeons, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgery Physician
- Petoskey, MI
- NPI 1730145574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386028800000",
"number": "1205189669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 N CENTER AVE",
"address_2": "SUITE 298",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497351595",
"telephone_number": "989-731-7708",
"fax_number": "989-731-7929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2147 PROFESSIONAL DR",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497350003",
"telephone_number": "989-732-1753",
"fax_number": "989-731-1425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ADRIENNE",
"middle_name": "MARGARET",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-23",
"last_updated": "2013-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207XS0114X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
"state": "MI",
"license": "4301101907",
"primary": false
},
{
"code": "207XS0117X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
"state": "MI",
"license": "4301101907",
"primary": true
},
{
"code": "207XX0801X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "MI",
"license": "4301101907",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "OF96004",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.