John Edward Kelly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9109928 Issued in FL

Practice address

1340 Citizens Blvd
Leesburg, FL 34748-3924

Phone

(352) 435-7695

Fax

(352) 435-7453

NPI assigned

Jan 3, 2017

Last updated

Jan 3, 2017By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Johnny Gurgen DO PAGroup PAC ID 1355504861, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.29 of 100Reported as group

Quality

90.57

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jkelly@drgurgen.emadirect.md

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.

• Johnny Gurgen DO PA

  • Dermatology Physician
  • Lady Lake, FL
  • NPI 1770856833
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483401600000",
    "number": "1255876041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1621",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344511621",
            "telephone_number": "352-726-2947",
            "fax_number": "352-435-7695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CITIZENS BLVD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483924",
            "telephone_number": "352-435-7695",
            "fax_number": "352-435-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-03",
        "last_updated": "2017-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Kasprick
• Keith Kastelic, MD
• Patricia Ann Kauffman, LPN
• Cathrine Elena Keller, M.D.
• Kilee J Kelly Sleeper, MSW, LCSW
• Gloria Jean Kennedy, LPN
• Kenneth Appah Sampong, P.a.
• Kenneth Henschel, MD, LLC (Kenneth Henschel, MD)
• Kenneth J. Cochrane, PH.D., LLC
• Matthew Kenney

• Physician Assistant in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.