NPIMap

Organization Active NPI

William M. Kelly M.D., Inc.

  • Diagnostic Neuroimaging (Radiology) Physician
  • Loma Linda, CA
National Provider Identifier
1295718161
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Radiology) PhysicianTaxonomy code 2085D0003X
License
A34125 Issued in CA
Legal business name
WILLIAM M. KELLY M.D., INC.
Practice address
11360 Mountain View Ave
Suite C
Loma Linda, CA 92354-3861
Phone
(909) 478-3300
Fax
(909) 478-3900
NPI assigned
Nov 23, 2005
Organization subpart
Yes
Parent organization
WILLIAM M. KELLY M.D., INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Authorized official

Name
Ms. Melonie Storer
Title
Credentialing Administrator
Phone
(951) 302-2223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Radiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085D0003X A34125 CA Primary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X A34125 CA

Addresses

Primary practice location

11360 Mountain View Ave
Suite C
Loma Linda, CA 92354-3861

Mailing address

44489 Town Center Way
Ste. D
Palm Desert, CA 92260-2789
Phone (760) 776-9777

Other identifiers 1

IdentifierTypeStateIssuer
00A341251MedicaidCA

Other names 1

  • Open MRI of Loma Linda Doing business as

National Provider Directory

National Provider Directory
Tax ID family
William M Kelly MD Inc10 organizations share this tax ID, including this one
Part of
William M Kelly MD Inc

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11360 Mountain View Ave
Ste C
Loma Linda, CA 92354
Phone (909) 478-3300

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1295718161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44489 TOWN CENTER WAY",
            "address_2": "STE. D",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922602789",
            "telephone_number": "760-776-9777",
            "fax_number": "760-776-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11360 MOUNTAIN VIEW AVE",
            "address_2": "SUITE C",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543861",
            "telephone_number": "909-478-3300",
            "fax_number": "909-478-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM M. KELLY M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM M. KELLY M.D., INC.",
        "enumeration_date": "2005-11-23",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "STORER",
        "authorized_official_first_name": "MELONIE",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "951-302-2223",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2085D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "CA",
            "license": "A34125",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A34125",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A341251",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open MRI of Loma Linda",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.