Mark E Kellam, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

35076218 Issued in OH

Practice address

3131 Queen City Ave
Cincinnati, OH 45238-2316

Phone

(513) 557-3333

Fax

(513) 557-3332

NPI assigned

Jun 16, 2005

Last updated

Apr 27, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WY, AZ, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Emergency Medicine

Education

University of Washington School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians Southwest PCGroup PAC ID 2264538529, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley View Medical Center Hospital, Fort Mohave, AZ, CCN 030117

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Emergency Physicians Southwest, PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1912053752
  Medicare reassignment Care Compare group NPD
• Campbell County Hospital District

  dba Campbell County Medical Group - Internal Medicine Clinic

  • Internal Medicine Physician
  • Gillette, WY
  • NPI 1710098868
  Medicare reassignment NPD
• Nes Arizona Inc

  • Emergency Medicine Physician
  • Benson, AZ
  • NPI 1205217700
  Medicare reassignment NPD
• Pine Ridge Indian Health Service Hospital

  dba Pine Ridge IHS Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412

  TX

  Medicare reassignment NPD
• Campbell County Hospital District

  dba Camp County Memorial Hospital - Physician Group

  • Emergency Medicine Physician
  • Gillette, WY
  • NPI 1063575611
  NPD
• Campbell County Hospital District

  dba Behavioral Health Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gillette, WY
  • NPI 1881730141
  NPD
• Campbell County Hospital District

  dba Campbell County Health

  • Community/Retail Pharmacy
  • Gillette, WY
  • NPI 1992874218
  NPD
• Nes Arizona Inc

  • Emergency Medicine Physician
  • Fort Mohave, AZ
  • NPI 1285163121
  NPD
• Pine Ridge Indian Health Service Hospital

  dba LaCreek District Clinic

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257
  NPD
• Pine Ridge Indian Health Service Hospital

  dba Wanblee Health Center

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD
• Qualified Emergency Specialists Inc

  • Emergency Medicine Physician
  • Montgomery, OH
  • NPI 1700872728
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• PHC-Fort Mohave Inc

  dba Valley View Medical Center

  • General Acute Care Hospital
  • Fort Mohave, AZ
  • NPI 1811086994
  Care Compare affiliation

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209254400000",
    "number": "1356346449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1472 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771004",
            "telephone_number": "513-557-3333",
            "fax_number": "513-557-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 QUEEN CITY AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452382316",
            "telephone_number": "513-557-3333",
            "fax_number": "513-557-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLAM",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2008-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35076218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2126907",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64963408",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200237920",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kelch, CNP
• Cassidy Kelien
• Kalika Kelkar
• Suzanne Kellagher, PHYSICAL THERAPIST
• Dorrinna Maria Kellam, STNA
• Jennifer Ann Kelleher
• Matthew Kelleher, M.D.
• Olivia Kelleher
• Keller Leasing Co, LLC (Kenwood Healthcare Center)
• Andrea R Keller, MSN, APRN, NP-C

• Emergency Medicine Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Emergency Medicine Physician in Ohio

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