Samuel Kellner, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

001121 Issued in CT

Practice address

171 Grandview Ave Ste 104
Waterbury, CT 06708-2517

Phone

(203) 753-2048

Fax

(203) 753-5891

NPI assigned

Jun 22, 2017

Last updated

Jun 7, 2023By 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

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Waterbury Podiatry ConsultantsGroup PAC ID 7911046883, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waterbury Hospital Hospital, Waterbury, CT, CCN 070005

Procedures performed for Medicare patients

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.

• Waterbury Podiatry Consultants

  • Podiatrist
  • Waterbury, CT
  • NPI 1447430467

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD
• Podiatry Group of New Britain/Southington. P.C.

  • Foot Surgery Podiatrist
  • Southington, CT
  • NPI 1164596482
  NPD (past)

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

• Prospect Waterbury, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1477902641
  Care Compare affiliation

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1386164077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVE STE 104",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082517",
            "telephone_number": "203-753-2048",
            "fax_number": "203-753-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVE STE 104",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082517",
            "telephone_number": "203-753-2048",
            "fax_number": "203-753-5891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLNER",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-22",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CT",
            "license": "001121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew F. Keene, DMD
• Raeven B Keene
• Andrew Keliar, LCSW
• Jennifer L Keller, APRN
• Grace Kelley, CRNA, APRN
• Elizabeth Anne Kelly, MD
• Krista G Kelly, BA,AS
• Paul F Kelly, M.D.
• Sheelagh Kelly
• Tina M. Kelly

• Foot & Ankle Surgery Podiatrist in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Foot & Ankle Surgery Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.