Michael J Kelly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

24314 Issued in IA

Practice address

1820 W 3Rd St
Genesis Health Group
Davenport, IA 52802-1812

Phone

(563) 421-0500

Fax

(563) 326-1901

NPI assigned

Jul 21, 2006

Last updated

Feb 15, 2013By 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 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mike.kelly@direct.genesishealth.com

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.

• Genesis Health System

  dba Genesis Family Medical Center

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1922012764
  NPD (past)
• Genesis Medical Education Foundation Inc

  dba Genesis Family Medical Center

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1659322931
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360886400000",
    "number": "1396766937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 WEST THIRD STREET",
            "address_2": "GENESIS HEALTH GROUP",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528020000",
            "telephone_number": "563-421-0500",
            "fax_number": "563-326-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 W 3RD ST",
            "address_2": "GENESIS HEALTH GROUP",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528021812",
            "telephone_number": "563-421-0500",
            "fax_number": "563-326-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2013-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-079295",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "24314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "14313",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS",
            "identifier": "2019320",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITY",
            "identifier": "390808509DX",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "390808509",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Kellenberger
• Brianne Keller, PT, DPT
• James M. Keller, D.C.
• Rachael Frances Jayne Kelley, TLMHC, LPC
• Christina Kelly, LMSW
• Natalie Frances Kelly, PHARMD
• Miluska Kendall
• Jessica Kent
• Phillip L Kent, PSY.D.
• Haley Kenyon

• Family Medicine Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.