Conrad Joseph Kelly

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704293196 Issued in MI

Practice address

22101 Moross Rd
Detroit, MI 48236

Phone

(313) 343-4000

NPI assigned

Jul 20, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Northstar Anesthesia of Michigan PLLCGroup PAC ID 9638481591, 192 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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 and National Provider Directory roles.

• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Northstar Anesthesia of Michigan PLLC

  • Anesthesiology Physician
  • Irving, TX
  • NPI 1871986372

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Botsford General Hospital

  • Certified Registered Nurse Anesthetist
  • Farmington Hills, MI
  • NPI 1235179664

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Henry Ford Health St. John Hospital

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
  • NPI 1598896995

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Rochester Medical Associates, PLLC

  • Anesthesiology Physician
  • Rochester Hills, MI
  • NPI 1396398681

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• William Beaumont Hospital

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1811044878

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Botsford General Hospital

  • Urgent Care Clinic/Center
  • Redford, MI
  • NPI 1831402056
  NPD
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD

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

• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532563200000",
    "number": "1437672516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 CULBERTSON AVE",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48236",
            "telephone_number": "313-343-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CONRAD",
        "middle_name": "JOSEPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-20",
        "last_updated": "2018-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704293196",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704293196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittni Kellom
• Ja'Keya Kellom, LPC
• Kelly Morang Pharmacy
• Kelly Plaza Dental CT. PC
• Monique Denise Kelly-Perkins
• Denise Ann Kelly, LMSW
• James Brian Kelly, M.D
• Jodie Ann Kelly
• Jolonda Kelly
• Karen Kelly, RN

• Certified Registered Nurse Anesthetist in Detroit, MI
• Providers in Detroit, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.