NPIMap

Individual provider Active NPI

Gregory B Kelly, MD

  • Internal Medicine Physician
  • White Marsh, MD
National Provider Identifier
1235213851
Registry record updated May 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D21242 Issued in MD
Practice address
4924 Campbell Boulevard
White Marsh, MD 21236
Phone
(443) 442-2300
Fax
(443) 442-2360
NPI assigned
Oct 24, 2006
Last updated
May 9, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D21242 MD Primary

Addresses

Primary practice location

4924 Campbell Boulevard
White Marsh, MD 21236

Mailing address

3100 Wyman Park Drive
Suite 359a
Baltimore, MD 21211

Other identifiers 1

IdentifierTypeStateIssuer
367271900MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100608000527 MD Practitioner - Internal MedicinePractitioner - Rheumatology 1355471947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Rheumatology
Education
George Washington University School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1000 E Eager St
E Baltimore Med Ctr
Baltimore, MD 21202-5533
Phone (410) 522-9800

4924 Campbell Blvd
Suite 200
Baltimore, MD 21236-5914
Phone (443) 442-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D21242MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins Community Physicians Internal Medicine CurrentSince Jan 1, 2001 Accepting new patients
Johns Hopkins Community Physicians, Inc Internal Medicine CurrentSince Jan 1, 2001 Accepting new patients
Johns Hopkins Community Physicians, Inc. Internal Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Johns Hopkins Community Physicians, Inc Past Accepting new patients

Locations

1000 E Eager St
Baltimore, MD 21202
Phone (410) 522-9800

3100 Wyman Park Dr
Baltimore, MD 21211
Phone (410) 338-3000

3100 Wyman Park Dr
Ste 359A
Baltimore, MD 21211
Phone (410) 338-3016

14207 Park Center Dr
Ste 102
Laurel, MD 20707
Phone (301) 604-5254

4924 Campbell Blvd
Nottingham, MD 21236
Phone (443) 442-2200

4924 Campbell Blvd
Ste 200
Nottingham, MD 21236
Phone (443) 442-2300

9910 Franklin Square Dr
#2110
Nottingham, MD 21236
Phone (410) 933-5412

Interoperability endpoints

  • Direct secure messaging: gkelly6850@direct.hopkinsmedicine.org

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1235213851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 WYMAN PARK DRIVE",
            "address_2": "SUITE 359A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 CAMPBELL BOULEVARD",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "21236",
            "telephone_number": "443-442-2300",
            "fax_number": "443-442-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "GREGORY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D21242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "367271900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Marsh, MD

Sources for this page

Verify at the official NPI Registry.