Active NPI
Vernon Charles Kelly Jr., M.D.
- Psychiatry Physician
- Wyndmoor, PA
National Provider Identifier
1215054028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD033301L
- Practice address
- 7948 Pleasant St
Wyndmoor, PA 19038-8533 - Phone
- (215) 836-5465
- Fax
- (610) 896-5540
- NPI assigned
- Mar 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD033301L | PA | Primary |
Addresses
Primary practice location
7948 Pleasant St
Wyndmoor, PA 19038-8533
Mailing address
7948 Pleasant St
Wyndmoor, PA 19038-8533
Phone (215) 836-5465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 5, 2016 through Feb 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD033301L | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215054028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7948 PLEASANT ST",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190388533",
"telephone_number": "215-836-5465",
"fax_number": "610-896-5540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7948 PLEASANT ST",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190388533",
"telephone_number": "215-836-5465",
"fax_number": "610-896-5540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "VERNON",
"middle_name": "CHARLES",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD033301L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyndmoor, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.