NPIMap

Individual provider Active NPI

Mark Kelly

  • Otolaryngology Physician
  • Laconia, NH
National Provider Identifier
1427016633
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
11416 Issued in NH
Practice address
85 Spring St
Laconia, NH 03246-3113
Phone
(603) 524-7402
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 11416 NH
Otolaryngic Allergy Physician 207YX0602X 11416 NH
Otolaryngology Physician 207Y00000X 11416 NH Primary

Addresses

Primary practice location

85 Spring St
Laconia, NH 03246-3113

Mailing address

85 Spring St
Laconia, NH 03246-3113
Phone (603) 524-7402

Other practice location 1

60 Commercial St Ste 401
Concord, NH 03301-5096
Phone (603) 789-9150

Other identifiers 2

IdentifierTypeStateIssuer
30201594MedicaidNH
3077628MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20060210000276 NH Practitioner - Otolaryngology 9739194838 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Jefferson Medical College of Thomas Jefferson University, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Hospital IncGroup PAC ID 6103721790, 572 clinicians
Concord Hospital-LaconiaGroup PAC ID 7012326259, 275 clinicians

Practice addresses (Care Compare)

246 Pleasant St
Concord, NH 03301-2548
Phone (603) 228-7200

80 Highland St
Laconia, NH 03246-3235
Phone (603) 527-2819

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as apm
Quality
73.23
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as apm
Quality
73.23
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11416NHMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Hospital, Inc. CurrentSince Apr 28, 2020 Accepting new patients
Concord Hospital, Inc. Current Accepting new patients
Concord Hospital-Franklin CurrentSince Sep 1, 2015 Accepting new patients
Concord Hospital, Inc. CurrentSince Apr 28, 2020 Accepting new patients
Concord Hospital-Laconia Otolaryngology CurrentSince Aug 1, 2022 Accepting new patients
Lrghealthcare CurrentSince Sep 1, 2015 Accepting new patients
Concord Hospital-Laconia Past Accepting new patients

Locations

246 Pleasant St
Concord, NH 03301
Phone (603) 224-1223

60 Commercial St
Ste 401
Concord, NH 03301
Phone (603) 228-7555

250 Pleasant St
Concord, NH 03301
Phone (603) 225-2711

15 Aiken Ave
Franklin, NH 03235
Phone (603) 934-2060

85 Spring St
Ste 402
Laconia, NH 03246
Phone (603) 527-2946

85 Spring St
Laconia, NH 03246
Phone (603) 524-7402

85 Spring St
Ste 104
Laconia, NH 03246
Phone (603) 524-7402

85 Spring St
#103
Laconia, NH 03246
Phone (603) 524-7402

85 Spring St
Ste 103
Laconia, NH 03246
Phone (603) 524-7402

80 Highland St
Laconia, NH 03246
Phone (603) 527-7100

238 Daniel Webster Hwy
Meredith, NH 03253
Phone (603) 279-7464

3073 White Mountain Hwy
North Conway, NH 03860
Phone (603) 356-5472

Organizations & group practices 7

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 12

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1427016633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SPRING ST",
            "city": "LACONIA",
            "state": "NH",
            "postal_code": "032463113",
            "telephone_number": "603-524-7402",
            "fax_number": "603-227-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SPRING ST",
            "city": "LACONIA",
            "state": "NH",
            "postal_code": "032463113",
            "telephone_number": "603-524-7402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Commercial St Ste 401",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NH",
            "postal_code": "033015096",
            "country_code": "US",
            "telephone_number": "603-789-9150",
            "fax_number": "603-227-7592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NH",
            "license": "11416",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "NH",
            "license": "11416",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NH",
            "license": "11416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30201594",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3077628",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laconia, NH

Sources for this page

Verify at the official NPI Registry.