Individual provider Active NPI

Kevin Kelley, CRNA

  • Certified Registered Nurse Anesthetist
  • Weymouth, MA
National Provider Identifier
1295813558
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
43888 Issued in MA
Practice address
163 Libbey Parkway
Suite 301
Weymouth, MA 02189-3118
Phone
(781) 337-4224
Fax
(781) 335-0429
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 166534 MA
Certified Registered Nurse Anesthetist 367500000X 43888 MA Primary

Addresses

Primary practice location

163 Libbey Parkway
Suite 301
Weymouth, MA 02189-3118

Mailing address

163 Libbey Parkway
Suite 301
Weymouth, MA 02189-3118
Phone (781) 337-4224

Other identifiers 1

IdentifierTypeStateIssuer
430051213OtherMAPALMETTO GBA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040105000573 MA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739088105 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Matrix Anesthesia PCGroup PAC ID 8820136377, 52 clinicians

Practice addresses (Care Compare)

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7642

Hospital & facility affiliations

  • Signature Healthcare Brockton Hospital Hospital, Brockton, MA, CCN 220052

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
166534MAMDRegistered Nurse
43888MAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Sep 8, 2020 Accepting new patients
Anesthesia Professionals, Inc. Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2023 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 8, 2020 Accepting new patients
South Suburban Gastroenterology, PC CurrentSince Sep 22, 2021 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Sep 8, 2020 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Current Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 8, 2020 Accepting new patients
South Shore Anesthesia Associates, Inc Past Accepting new patients
Weymouth Endoscopy, LLC PastSince Sep 22, 2021 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

145 West St
Milford, MA 01757
Phone (508) 381-5600

25 Highland Ave
Newburyport, MA 01950
Phone (978) 258-4734

146 Industrial Park Rd
Plymouth, MA 02360
Phone (508) 833-6000

282 Route 130
Sandwich, MA 02563
Phone (508) 427-3720

175 Worcester St
Wellesley Hls, MA 02481
Phone (617) 272-0004

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

1085 Main St
Weymouth, MA 02190
Phone (781) 331-2922

97 Libbey Park
Ste 300
Weymouth, MA 02189
Phone (781) 331-2922

400 10th St E
Waconia, MN 55387

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1295813558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 LIBBEY PARKWAY",
            "address_2": "SUITE 301",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021893118",
            "telephone_number": "781-337-4224",
            "fax_number": "781-335-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 LIBBEY PARKWAY",
            "address_2": "SUITE 301",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021893118",
            "telephone_number": "781-337-4224",
            "fax_number": "781-335-0429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KEVIN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "166534",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "43888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "430051213",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.