Timothy Kelley, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

10994 Issued in TN

Practice address

877 Jefferson Ave
Memphis, TN 38103-2807

Phone

(901) 448-5893

Fax

(901) 448-5540

NPI assigned

May 1, 2006

Last updated

Jun 30, 2016By 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 1

Medicare fee-for-service enrollment

Enrolled in TN, MO2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110

Merit-based Incentive Payment System (MIPS)

Final score

80.97 of 100Reported as group

Quality

64.58

Improvement activities

40

Cost

77.33

Merit-based Incentive Payment System (MIPS)

Final score

80.94 of 100Reported as group

Quality

61.89

Promoting interoperability

100

Improvement activities

40

Cost

74.58

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Southeast Missouri Hospital Physicians, LLC

  dba Mercy Clinic Southeast

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• East Memphis Anesthesia Services PLC

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1578592663
  Medicare reassignment NPD
• Lifelinc Anesthesia, PLLC

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1801021464

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Resource Anesthesiology Associates of TN PC

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1316724073

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Ut Regional One Physicians Inc

  • Surgery Physician
  • Memphis, TN
  • NPI 1093130585

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Ut Regional One Physicians Inc

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1285042028

  Nurse Anesthetist, Certified Registered

  NPD

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

• Southeast Hospital

  dba Mercy Hospital Southeast

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1376501395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "address_2": "ATTN: PROVIDER ENROLLMENT",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-448-5893",
            "fax_number": "901-448-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "10994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3628056",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy J Kelley, MSN
• Laurel Kelley, OD
• Misty D Kelley, CRNA
• Patricia A. Kelley, PH.D.
• Stephen Earl Kelley, CRNA
• Abigail Phipps Kellis, DO
• Rebecca Ann Kellum, DPH
• Thomas Purnell Kelly III, D.PH.
• Alexis Sierra Lynn Kelly, MS, LPC/MHSP
• Annie Kelly

• Certified Registered Nurse Anesthetist in Memphis, TN
• Providers in Memphis, TN by specialty
• Certified Registered Nurse Anesthetist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.