Ian Kelly

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

105802 Issued in CA

Practice address

9479 Haven Ave
Rancho Cucamonga, CA 91730-5844

Phone

(909) 771-8023

NPI assigned

Jan 15, 2016

Last updated

Dec 12, 2018By the provider in NPPES

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 CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Through the Sea Marriage and Family Counseling IncGroup PAC ID 3870932692, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Through the Sea Marriage and Family Counseling Inc

  • Marriage & Family Therapist
  • West Covina, CA
  • NPI 1093281990
  Medicare reassignment Care Compare group NPD
• Descanso Home Health Services

  • Home Health Agency
  • Covina, CA
  • NPI 1437504990
  NPD (past)
• Jeffrey N Mar MD Inc

  • Child & Adolescent Psychiatry Physician
  • Rancho Cucamonga, CA
  • NPI 1023279056
  NPD (past)
• Jeffrey N. Mar, M.D., Inc.

  dba Valenta, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Rancho Cucamonga, CA
  • NPI 1760508121
  NPD (past)

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1336506781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9479 HAVEN AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9479 HAVEN AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305844",
            "telephone_number": "909-771-8023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "IAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-15",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "105802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Clete Keen, DDS
• Rachel Joy Keener
• John Kelleher
• Demetri Rashad Kelley
• Afton Valley Kelly
• Aishah Kelsick-Ricks
• Carla Ann Kendig, AMFT
• Peter Kennedy Jr., LCSW
• Kenneth Myers Chiropractic Corporation (San Antonio Pain Relief Center)
• Lily Kenney

• Marriage & Family Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.