NPIMap

Individual provider Active NPI

Fred A Kelly II, ARNP

  • Family Nurse Practitioner
  • Maitland, FL
National Provider Identifier
1407399470
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9366837 Issued in FL
Practice address
500 Winderley PL #115
Maitland, FL 32751
Phone
(407) 952-5705
NPI assigned
Nov 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9366837 FL Primary

Addresses

Primary practice location

500 Winderley PL #115
Maitland, FL 32751

Mailing address

1114 Cambridge St
Deltona, FL 32725-3652
Phone (407) 952-5705

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170310001381 FL Practitioner - Nurse Practitioner 5890079826 Reassigns benefits to 2 organizations
I20230109000623 MT Practitioner - Nurse Practitioner 5890079826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McCone County Health Center IncGroup PAC ID 8921078957, shared by 3 NPIs, 5 clinicians

Practice addresses (Care Compare)

605 Sullivan Ave
Circle, MT 59215-0048

PO Box
Suite 48
Circle, MT 59215-0048

Hospital & facility affiliations

  • McCone County Health Center Hospital, Circle, MT, CCN 271305
  • Glendive Medical Center Hospital, Glendive, MT, CCN 271332
  • Intermountain Health St Vincent Regional Hospital Hospital, Billings, MT, CCN 270049
  • Billings Clinic Hospital Hospital, Billings, MT, CCN 270004
  • Holy Rosary Hospital Hospital, Miles City, MT, CCN 271347
  • McCone County Health Center Nursing home, CCN 27Z305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9366837FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
McCone County Health Center Inc CurrentSince Sep 8, 2022 Accepting new patients
McCone County Health Center Inc Current Accepting new patients
Inpatient Consultants of Florida, Inc CurrentSince Mar 29, 2021 Accepting new patients
McCone County Health Center, Inc. Current Accepting new patients
Inpatient Consultants of Florida, Inc Current Accepting new patients
Inpatient Consultants of Florida Inc CurrentSince Mar 29, 2021 Accepting new patients
Florida Emergency Physicians Kang and Associates MD LLC CurrentSince Feb 1, 2017 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1909 E Highway 50
Clermont, FL 34711
Phone (352) 717-3800

12980 SW Highway 484
Dunnellon, FL 34432
Phone (352) 229-8465

2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

Interoperability endpoints

  • Direct secure messaging: fred.kelly.1@16866.direct.athenahealth.com
  • Direct secure messaging: fred.kelly.1@33524.direct.athenahealth.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1407399470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 CAMBRIDGE ST",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327253652",
            "telephone_number": "407-952-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL #115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751",
            "telephone_number": "407-952-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "FRED",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-23",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9366837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.