NPIMap

Individual provider Active NPI

Christopher Patrick Kelly, PAC

  • Physician Assistant
  • Gilbert, WV
National Provider Identifier
1407137110
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2800 Issued in WV
Practice address
202 Larry Joe Harless Dr.
Gilbert, WV 25621-1842
Phone
(304) 664-6270
Fax
(304) 664-6272
NPI assigned
Sep 8, 2011
Last updated
Apr 3, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2800 WV Primary
Physician Assistant 363A00000X 01578 WV
Physician Assistant 363A00000X 601 WV

Addresses

Primary practice location

202 Larry Joe Harless Dr.
Gilbert, WV 25621-1842

Mailing address

7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806

Other identifiers 1

IdentifierTypeStateIssuer
3810025900MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20111011000000 WV Practitioner - Physician Assistant 9537331830 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lincoln County Primary Care Center IncGroup PAC ID 6204821879, shared by 25 NPIs, 40 clinicians

Practice addresses (Care Compare)

7400 Lynn Ave
Hamlin, WV 25523-1138

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
601WVMDProfessional Counselor
01578WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. CurrentSince Jun 1, 2013 Accepting new patients
West Virginia University Medical Corporation CurrentSince May 25, 2022 Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
West Virginia University Medical Corporation CurrentSince May 25, 2022 Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. CurrentSince Jun 1, 2013 Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc CurrentSince Jun 1, 2013 Accepting new patients
Lincoln County Primary Care Center, Inc Past Accepting new patients
Marshall West Virginia Ed Associates, LLC Past Accepting new patients

Locations

1710 Harper Rd
Beckley, WV 25801
Phone (304) 252-0641

5322 McClellan Hwy
Branchland, WV 25506
Phone (304) 824-5707

506 Crawley Creek Rd
Chapmanville, WV 25508
Phone (304) 855-0245

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

621 Larry Joe Harless Dr
Gilbert, WV 25621
Phone (304) 664-1147

7400 Lynn Ave
Hamlin, WV 25523

81 Lincoln Panther Way
Hamlin, WV 25523
Phone (304) 824-6090

1 Wildcat Way
Logan, WV 25601
Phone (304) 688-9949

122 Nick Savas Dr
Logan, WV 25601
Phone (304) 752-8081

471 Main St
Madison, WV 25130
Phone (304) 369-5170

1 Pioneer Path
Man, WV 25635
Phone (304) 583-7295

600 E McDonald Ave
Man, WV 25635
Phone (304) 583-6541

650 E McDonald Ave
Man, WV 25635
Phone (304) 583-8585

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

59 Vanatters Crk
Ranger, WV 25557
Phone (304) 778-3084

1563 Sand Plant Rd
South Charleston, WV 25309
Phone (304) 756-1500

Interoperability endpoints

  • Direct secure messaging: christopher.kelly.1@6401.direct.athenahealth.com
  • Direct secure messaging: ckelly337823@direct.wvuhsdirect.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1407137110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 LARRY JOE HARLESS DR.",
            "city": "GILBERT",
            "state": "WV",
            "postal_code": "256211842",
            "telephone_number": "304-664-6270",
            "fax_number": "304-664-6272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHRISTOPHER",
        "middle_name": "PATRICK",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-08",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2800",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01578",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "601",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810025900",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, WV

Sources for this page

Verify at the official NPI Registry.