NPIMap

Individual provider Active NPI

John Kelly, MD

  • Internal Medicine Physician
  • Bloomfield, NJ
National Provider Identifier
1265540686
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA51866 Issued in NJ
Practice address
382 W Passaic Ave
Bloomfield, NJ 07003-5552
Phone
(973) 338-1900
Fax
(973) 761-0112
NPI assigned
Aug 27, 2006
Last updated
Aug 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 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 MA51866 NJ Primary

Addresses

Primary practice location

382 W Passaic Ave
Bloomfield, NJ 07003-5552

Mailing address

382 W Passaic Ave
Bloomfield, NJ 07003-5552
Phone (973) 338-1900

Other identifiers 1

IdentifierTypeStateIssuer
1753606MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20050726000036 NJ Practitioner - Internal Medicine 4486681376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John V Kelly MD PCGroup PAC ID 9638106891, 5 clinicians

Practice addresses (Care Compare)

382 W Passaic Ave
Bloomfield, NJ 07003-5554
Phone (973) 338-1900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA51866NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John V. Kelly MD, PC Internal Medicine CurrentSince Nov 12, 1995 Accepting new patients
Clara Maass Medical Center Past Accepting new patients

Locations

382 W Passaic Ave
Bloomfield, NJ 07003
Phone (973) 338-1383

Interoperability endpoints

  • Direct secure messaging: jkelly229605@epicdirect.rwjbh.org

Organizations & group practices 2

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 11

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": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1265540686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 W PASSAIC AVE",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070035552",
            "telephone_number": "973-338-1900",
            "fax_number": "973-761-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 W PASSAIC AVE",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070035552",
            "telephone_number": "973-338-1900",
            "fax_number": "973-761-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA51866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1753606",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

Verify at the official NPI Registry.