Russell Phelps Kelley IV, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

1018091 Issued in MA

Practice address

2825 Oak Lawn Ave Unit 192749
Dallas, TX 75219-4688

Phone

(510) 689-9500

Fax

(877) 880-2039

NPI assigned

Jun 11, 2013

Last updated

Dec 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, MA2 enrollments

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 2

Specialty

Diagnostic Radiology

Education

Harvard Medical School, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Radiology Group IncGroup PAC ID 7113817149, 31 clinicians

Blue Ridge Healthcare Medical Group IncGroup PAC ID 9436159712, 222 clinicians

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014
• Adventist Health Castle Hospital, Kailua, HI, CCN 120006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Blue Ridge Healthcare Medical Group Inc

  dba BRHC Radiology Practice

  • Diagnostic Radiology Physician
  • Morganton, NC
  • NPI 1639244478

  MA

  Medicare reassignment Care Compare group NPD
• Pacific Radiology Group Inc

  • Specialist
  • Honolulu, HI
  • NPI 1871577536

  Diagnostic Radiology, MA

  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  dba SGMF Radiology

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1174997407

  MA

  Medicare reassignment Care Compare group NPD
• St Agnes Healthcare Inc

  dba Integrated Specialists Group

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176

  MA

  Medicare reassignment NPD
• Stanford Health Care

  dba Stanford Medical Center A Trade Name for Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927

  Internal Medicine, MA

  Medicare reassignment NPD
• University of California SFGH Medical Group

  dba UCSF SFGH Medical Group Dept of Radiology

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1063487122
  Medicare reassignment NPD
• University of Texas Southwestern Medical Center at Dallas

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1942270566
  NPD
• Blue Ridge Healthcare Medical Group Inc

  dba Blue Ridge Radiology

  • Diagnostic Radiology Physician
  • Hickory, NC
  • NPI 1578842035
  NPD
• Blue Ridge Healthcare Medical Group, Inc.

  dba Blue Ridge Transitional Care Clinic

  • Internal Medicine Physician
  • Morganton, NC
  • NPI 1578424685
  NPD
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD
• Stanford Health Care

  dba Stanford Health Care Specialty Pharmacy

  • Specialty Pharmacy
  • Mountain View, CA
  • NPI 1760366132
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Castle Medical Center

  • General Acute Care Hospital
  • Kailua, HI
  • NPI 1316937691
  Care Compare affiliation
• Sutter Valley Hospitals

  dba Sutter Amador Hospital

  • General Acute Care Hospital
  • Jackson, CA
  • NPI 1447494323
  Care Compare affiliation

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1215375373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "510-683-9500",
            "fax_number": "877-880-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "510-689-9500",
            "fax_number": "877-880-2039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Francis St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021156110",
            "country_code": "US",
            "telephone_number": "617-732-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "RUSSELL",
        "middle_name": "PHELPS",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "S3004",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A135999",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2024-03651",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1018091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Layne Elizabeth Kelley, MD
• Margaret M Kelley, P.A.-C
• Mary Lee Kelley, LCDC
• Matthew Kelley
• Megan Elizabeth Kelley
• Shannon Kelley, M.D.
• Sonia Kelley, OD, MS
• Urszula Barbara Kelley, M.D.
• Victoria P Kelley, NP
• Kelling Plastic Surgery, P.a. (Kelling Plastic Surgery)

• Diagnostic Radiology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.