Individual provider Active NPI

Dillon Michael Kelly, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1366041402
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9115478 Issued in FL
Practice address
9400 Turkey Lake Rd
Orlando, FL 32819-8001
Phone
(407) 351-8587
NPI assigned
Oct 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9115478 FL Primary
Physician Assistant 363A00000X 324554 LA

Addresses

Primary practice location

9400 Turkey Lake Rd
Orlando, FL 32819-8001

Mailing address

9400 Turkey Lake Rd
Orlando, FL 32819-8001
Phone (407) 351-8587

Other practice location 1

1214 Coolidge St.
Lafayette, LA 70503-2621
Phone (337) 289-7991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221027001437 FL Practitioner - Physician Assistant 3072925056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.2 of 100Reported as group
Quality
78.64
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9115478FLMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: dkelly1446370@direct.ochsner.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1366041402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 TURKEY LAKE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198001",
            "telephone_number": "407-351-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 TURKEY LAKE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198001",
            "telephone_number": "407-351-8587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1214 Coolidge St.",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705032621",
            "country_code": "US",
            "telephone_number": "337-289-7991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DILLON",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-20",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115478",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "324554",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.