Sean Kelly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601008056 Issued in MI

Practice address

1105 6TH St
Traverse City, MI 49684-2349

Phone

(231) 947-0673

Fax

(801) 740-2847

NPI assigned

Jan 9, 2017

Last updated

Mar 29, 2021By 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Physiotherapy Associates IncGroup PAC ID 3577470442, 1,432 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Medical Center Hospital, Saginaw, MI, CCN 230070

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skelly72856@direct.covenanthealthcare.com

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.

• Covenant Medical Center, Inc.

  dba Covenant HealthCare

  • Emergency Medicine Physician
  • Saginaw, MI
  • NPI 1972590412
  Medicare reassignment Care Compare group
• Northwestern Michigan Emergency Physicians PC

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1073597944
  Medicare reassignment
• Physiotherapy Associates Inc

  • Rehabilitation Clinic/Center
  • East Harwich, MA
  • NPI 1629165634
  Care Compare group
• Covenant Medical Center, Inc

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1619412376
  NPD
• Covenant Medical Center, Inc.

  • Urgent Care Clinic/Center
  • Saginaw, MI
  • NPI 1992993695
  NPD
• Traverse Observation Physician Services PC

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1851671697
  NPD (past)

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

• Covenant Medical Center, Inc.

  dba Covenant Healthcare

  • General Acute Care Hospital
  • Saginaw, MI
  • NPI 1588656946
  Care Compare affiliation

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1285170738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 N SPIDER LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968440",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842349",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-09",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "5601008056",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skelly72856@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "1105 6th St",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katherine Grace Kelly
• Kevin Charles Kelly, D.D.S.
• Kimberly Kelly, PSYD
• Marcy Kelly
• Patrick Calvin Kelly, D.D.S.
• Marjorie L Kelsey, FNP
• Darby Kelso
• Christy Marie Kemner
• Brynna Kemp
• Raegan Leigh Kendall

• Physician Assistant in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.