Teresa Gross Kelly, M.D

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301052060 Issued in MI

Practice address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Phone

(616) 363-7272

Fax

(616) 361-5828

NPI assigned

May 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Teresa Kelly Former name

Medicare fee-for-service enrollment

Enrolled in WI, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Diagnostic RadiologyAlso: Pediatric Medicine

Education

Stanford University School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
• Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tkellymd142429@direct.froedtert.com
• Direct secure messaging: tkelly7245@direct.chw.org

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.

• Advanced Radiology Services PC

  • Diagnostic Radiology Physician
  • Grand Rapids, MI
  • NPI 1740283324

  WI

  Medicare reassignment Care Compare group NPD
• Children's Specialty Group, Inc.

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1942970405
  Medicare reassignment NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1568787448
  Medicare reassignment NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Wauwatosa, WI
  • NPI 1154947224
  NPD
• UCLA Radiology Medical Group

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1881670248

  Pediatric Radiology

  NPD (past)

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

• Bronson Battle Creek Hospital

  • General Acute Care Hospital
  • Battle Creek, MI
  • NPI 1083644579
  Care Compare affiliation
• Bronson Methodist Hospital

  • General Acute Care Hospital
  • Kalamazoo, MI
  • NPI 1831116441
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• Mymichigan Medical Center Midland

  • Multi-Specialty Clinic/Center
  • Midland, MI
  • NPI 1205889490

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Midland

  dba Family Practice Center

  • General Acute Care Hospital
  • Midland, MI
  • NPI 1376973149
  Care Compare affiliation
• Mymichigan Medical Center Midland

  • General Acute Care Hospital
  • Midland, MI
  • NPI 1902841414
  Care Compare affiliation
• Pennock Hospital

  dba Corewell Health Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1275580672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 W Wisconsin Ave",
            "address_2": "PEDIATRIC RADIOLOGY",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264874",
            "country_code": "US",
            "telephone_number": "414-266-1686",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-805-2060",
            "fax_number": "414-259-9290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TERESA",
        "middle_name": "GROSS",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301052060",
            "primary": true
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "WI",
            "license": "52993",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": "ME70684",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275580672",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250150300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "KELLY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendra Kelly
• Rachael Joy Kelly, LLPC
• Ryan Kelly, MD
• Sophie Grace Kelly
• Sydney E Kelly, CCC-SLP
• John Philip Kelpin Jr., M.D.
• Sydney Kelpin, PHD
• Jill Ann Kelsay, M.S.
• Kelsey Rondeau Counseling, LLC
• Laura J Kelsey, M.D.

• Diagnostic Radiology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.