Individual provider Active NPI

Kelli Tavares, M.D.

  • Colon & Rectal Surgery Physician
  • Tripler Army Medical Center, HI
National Provider Identifier
1205216694
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
U7529 Issued in TX
Practice address
1 Jarrett White Rd
Tripler Army Medical Center, HI 96859-5001
Phone
(808) 433-1076
NPI assigned
Jun 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 19161 HI
Surgery Physician 208600000X U7529 TX
Colon & Rectal Surgery Physician 208C00000X U7529 TX Primary

Addresses

Primary practice location

1 Jarrett White Rd
Tripler Army Medical Center, HI 96859-5001

Mailing address

5130 Gateway Blvd E
El Paso, TX 79905-1608
Phone (915) 215-4480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240415002474 TX Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 2860877289 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19161HIMDSurgery Physician
U7529TXMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center El Paso CurrentSince May 1, 2024 Accepting new patients
Texas Tech University Health Sciences Center El Paso CurrentSince May 1, 2024 Accepting new patients
Texas Tech University Health Sciences Center El Paso Current Accepting new patients

Locations

4801 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5200

4815 Alameda Ave
El Paso, TX 79905
Phone (915) 215-6000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1205216694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 GATEWAY BLVD E",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799051608",
            "telephone_number": "915-215-4480",
            "fax_number": "915-215-5386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER ARMY MEDICAL CENTER",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVARES",
        "first_name": "KELLI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "HI",
            "license": "19161",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "U7529",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "TX",
            "license": "U7529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tripler Army Medical Center, HI

Sources for this page

Verify at the official NPI Registry.