Matthew Ryan Kelsey, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6751 Issued in NE

Practice address

17785 Mason St
#103
Omaha, NE 68118-3526

Phone

(402) 934-4745

Fax

(402) 934-4760

NPI assigned

Jun 25, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Kelsey Periodontal Group, LLC

  • Dental Clinic/Center
  • Omaha, NE
  • NPI 1831423177
  NPD (past)

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1326200072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17785 MASON ST",
            "address_2": "#103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681183526",
            "telephone_number": "402-934-4745",
            "fax_number": "402-934-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17785 MASON ST",
            "address_2": "#103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681183526",
            "telephone_number": "402-934-4745",
            "fax_number": "402-934-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSEY",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NE",
            "license": "6751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Leeann Kelnhofer
• Kelsey Periodontal Group, LLC
• Kelsey Raymond LLC
• Cindy Sue Kelsey, RN
• Mary Nan Kelsey IV, D.D.S.
• Sara Jeannette Kelsey, RD, LMNT
• Tiffani L Kelsey
• William Patrick Kelsey V
• William Patrick Kelsey III, D.D.S.
• Shania Kelso

• Periodontics in Omaha, NE
• Providers in Omaha, NE by specialty
• Periodontics in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.