NPIMap

Organization Active NPI

Kelly Otp LLC

  • Methadone Clinic
  • Roseville, MI
National Provider Identifier
1265150767
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
KELLY OTP LLC
Practice address
25200 Kelly Rd
Roseville, MI 48066-4473
Phone
(586) 422-1250
NPI assigned
Aug 19, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Authorized official

Name
Aaron Douglas Alston
Title
Pratice Administrator
Phone
(248) 971-0150

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Medical Specialty Clinic/Center 261QM2500X
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

25200 Kelly Rd
Roseville, MI 48066-4473

Mailing address

7 Riverbank Dr
Beverly Hills, MI 48025-4800
Phone (248) 971-0150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since Dec 1, 2023

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220930000595 MI Part B Supplier - Clinic/Group Practice 0446636385 Receives reassigned benefits from 4 practitioners
Practice locations: Roseville, MI
O20241214000172 MI Part A Provider - Opioid Treatment Program (Otp) 0446636385 Practice locations: Roseville, MI

National Provider Directory

National Provider Directory

Locations

25200 Kelly Rd
Roseville, MI 48066
Phone (586) 422-1250

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1265150767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 RIVERBANK DR",
            "city": "BEVERLY HILLS",
            "state": "MI",
            "postal_code": "480254800",
            "telephone_number": "248-971-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25200 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664473",
            "telephone_number": "586-422-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY OTP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-19",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "ALSTON",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRATICE ADMINISTRATOR",
        "authorized_official_telephone_number": "248-971-0150"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.