Martin J. Kelly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

000979 Issued in CT

Practice address

263 Farmington Ave
Provider Enrollment
Farmington, CT 06030-2212

Phone

(860) 679-7503

Fax

(860) 679-1610

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

George Washington University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hartford Healthcare Urgent Care Centers LLCGroup PAC ID 7618242777, 201 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: martin.kelly2@xdr.hhchealthdirect.org

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.

• Hartford Healthcare Urgent Care Centers, LLC

  • Urgent Care Clinic/Center
  • Avon, CT
  • NPI 1093239683
  Medicare reassignment Care Compare group
• Hartford Healthcare Medical Group, Inc

  • Surgery Physician
  • Wethersfield, CT
  • NPI 1043561301

  Physician Assistant

  Medicare reassignment NPD
• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment
• Prospect Manchester Hospital, Inc.

  • General Acute Care Hospital
  • Manchester, CT
  • NPI 1316394638
  Medicare reassignment
• State of Connecticut

  • General Acute Care Hospital
  • Farmington, CT
  • NPI 1669466561
  Medicare reassignment
• Prospect Manchester Hospital, Inc.

  • Health Educator
  • South Windsor, CT
  • NPI 1821695222
  NPD
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD
• State of Connecticut

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Storrs, CT
  • NPI 1871095851
  NPD
• Eastern Connecticut Medical Professionals Foundation Inc

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1770557712
  NPD (past)
• Eastern Connecticut Medical Professionals Foundation, Inc

  • Specialist
  • South Windsor, CT
  • NPI 1497864516
  NPD (past)
• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1447300702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302212",
            "telephone_number": "860-679-7503",
            "fax_number": "860-679-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302212",
            "telephone_number": "860-679-7503",
            "fax_number": "860-679-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARTIN",
        "middle_name": "J.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "000979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003009792",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE LIC",
            "identifier": "30656",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "000979",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Kellner, M.D.
• Andrew Kelly
• Christopher Kelly
• John Robert Kelly, DDS
• Martin J. Kelly, LPC
• Sharon P. Kelly, APRN
• Shelly-Ann Benesia Kelly, P.A.
• William Taylor Kelsey, PA
• Andrew Kemerley, DO
• Karen Kemp-Prosterman, DDS

• Physician Assistant in Farmington, CT
• Providers in Farmington, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.