NPIMap

Individual provider Active NPI

Brandon Reyes Kelly, M.D.

  • Neurological Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1295942142
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A11613 Issued in CA
Practice address
3345 Potomac Way
Idaho Falls, ID 83404-4978
Phone
(208) 552-6210
Fax
(208) 552-2027
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X A11613 CA Primary

Addresses

Primary practice location

3345 Potomac Way
Idaho Falls, ID 83404-4978

Mailing address

PO Box 277381
Atlanta, GA 30384-7381

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BRANDON.KELLY@hca3.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20120807000268 ID Practitioner - Neurosurgery 1759550429 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
New York University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Physician Services IncGroup PAC ID 2163430943, 18 clinicians

Practice addresses (Care Compare)

3345 Potomac Way
Idaho Falls, ID 83404-4978
Phone (208) 522-7572

Hospital & facility affiliations

  • Aspen Home Health Services Home health agency, Idaho Falls, ID, CCN 137081
  • Eden Home Health -Idahofalls Home health agency, Idaho Falls, ID, CCN 137119
  • Brio Idaho Healthcare Home health agency, Idaho Falls, ID, CCN 137128
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018
  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
  • Madison Memorial Hospital Hospital, Rexburg, ID, CCN 130025
  • Bingham Memorial Hospital Hospital, Blackfoot, ID, CCN 131325

Merit-based Incentive Payment System (MIPS)

Final score
77.68 of 100Reported as individual
Quality
62.6
Promoting interoperability
100
Improvement activities
40
Cost
63

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion467
Laminectomy or laminotomy (partial removal of spine bones)85

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A11613CAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Group, Inc. Neurological Surgery CurrentSince Jun 1, 2011 Accepting new patients
Idaho Physician Services Inc. CurrentSince Jan 1, 2021 Accepting new patients
City of Hope Medical Foundation Neurological Surgery Current Accepting new patients

Locations

1500 Duarte Rd
Bldg 149
Duarte, CA 91010
Phone (626) 359-8111

209 Fair Oaks Ave
South Pasadena, CA 91030
Phone (626) 359-8111

3345 Potomac Way
Idaho Falls, ID 83404
Phone (208) 417-0090

2860 Channing Way
Ste 116
Idaho Falls, ID 83404
Phone (208) 529-0575

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 3

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 10

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1295942142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277381",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044978",
            "telephone_number": "208-552-6210",
            "fax_number": "208-552-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "BRANDON",
        "middle_name": "REYES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2022-02-01",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A11613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BRANDON.KELLY@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "3345 Potomac Way",
            "city": "Idaho Falls",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834044978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.