Kelly Bickle MD Inc

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

A95166 Issued in CA

Legal business name

KELLY BICKLE MD INC

Doing business as

KELLY BICKLE, MD

Practice address

1244 7TH St Ste 204
Santa Monica, CA 90401-1648

Phone

(310) 878-4590

Fax

(424) 214-3301

NPI assigned

Nov 21, 2017

Organization subpart

No

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

Authorized official

Name

Kelly Bickle, MDNPI 1417926726

Title

Owner

Phone

(310) 878-4590

Specialties & licenses 1

Addresses

Other names 1

• KELLY BICKLE, MD Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly McCabe Bickle, MD

  • Dermatology Physician
  • Lakeland, FL
  • NPI 1417926726

  CA

  Medicare reassignment Authorized official
• Sabrina Barrow, PA-C

  • Physician Assistant
  • Santa Monica, CA
  • NPI 1386354009
  NPD (past)

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1255845657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1244 7TH ST STE 204",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011648",
            "telephone_number": "310-878-4590",
            "fax_number": "424-214-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 7TH ST STE 204",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011648",
            "telephone_number": "310-878-4590",
            "fax_number": "424-214-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY BICKLE MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-21",
        "last_updated": "2017-11-21",
        "status": "A",
        "authorized_official_last_name": "BICKLE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-878-4590",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "A95166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KELLY BICKLE, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Sargious Kehl, MD
• Devin Kehl, M.D.
• Farhad Keliddari, M.D.
• Elizabeth Greer Keller
• Lisa Anne Kelley
• Colleen Mary Saoirse Kelly, MFT
• Daniel F Kelly, MD
• Josie Kelly, MFT
• Kelsey Harper, Psychologist Incorporated
• Paul Kelson

• Dermatopathology Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Dermatopathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.