NPIMap

Individual provider Active NPI

Richard Joseph Kelly, MD

  • Family Medicine Physician
  • Crockett, TX
National Provider Identifier
1376535419
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F4152 Issued in TX
Practice address
1050 E Loop 304
Ste 200
Crockett, TX 75835-1814
Phone
(936) 544-5132
Fax
(936) 544-5572
NPI assigned
Aug 16, 2005
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X F4152 TX Primary

Addresses

Primary practice location

1050 E Loop 304
Ste 200
Crockett, TX 75835-1814

Mailing address

1050 E Loop 304
Ste 200
Crockett, TX 75835-1814
Phone (936) 544-5132

Other identifiers 1

IdentifierTypeStateIssuer
136297202MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110623000137 TX Practitioner - Family Practice 0941488803 Reassigns benefits to 3 organizations
Practice locations: Crockett, TX

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at Houston, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 E Loop
304 Crockett Medical Center Clinic
Crockett, TX 75835-1814
Phone (979) 543-6251

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
F4152TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid Coast Medical Center Crockett Inc CurrentSince Jun 1, 2018 Accepting new patients
Crockett Medical Center, LLC Family Medicine CurrentSince Jun 1, 2018 Accepting new patients
Mid Coast Medical Center Crockett Inc Past Accepting new patients
Crockett Clinic LLP Family Medicine Past Accepting new patients

Locations

1050 E Loop 304
Crockett, TX 75835
Phone (936) 544-2236

1050 E Loop 304
Ste 200
Crockett, TX 75835
Phone (936) 544-5132

1050 E Loop 304
Ste 201
Crockett, TX 75835
Phone (936) 546-3890

1100 E Loop 304
Crockett, TX 75835
Phone (936) 546-3862

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17821/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/b4348b5b-bd9c-4bea-a3a3-0691137fbf46/

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1376535419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 E LOOP 304",
            "address_2": "STE 200",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-544-5132",
            "fax_number": "936-544-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 E LOOP 304",
            "address_2": "STE 200",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-544-5132",
            "fax_number": "936-544-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F4152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136297202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crockett, TX

Sources for this page

Verify at the official NPI Registry.