NPIMap

Organization Active NPI

Kelly Medical, PC

Doing business as Kelly Family Medicine

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1467495226
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KELLY MEDICAL, PC
Doing business as
Kelly Family Medicine
Practice address
13921 N Meridian Ave Ste 100
Oklahoma City, OK 73134-1106
Phone
(405) 752-9600
Fax
(405) 752-9650
NPI assigned
Jun 13, 2006
Last updated
Oct 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Authorized official

Name
Stephen Blake Kelly, MDNPI 1134167455
Title
Doctor
Phone
(405) 752-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU
Interventional Pain Medicine Physician 208VP0014X NU

Addresses

Primary practice location

13921 N Meridian Ave Ste 100
Oklahoma City, OK 73134-1106

Mailing address

PO Box 268938
Oklahoma City, OK 73126-8938
Phone (405) 752-9600

Other names 1

  • Kelly Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060629000008 OK Part B Supplier - Clinic/Group Practice 3173535515 Receives reassigned benefits from 13 practitioners
Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory

Locations

3705 W Memorial Rd
Ste 601
Oklahoma City, OK 73134
Phone (405) 749-0900

5101 Gaillardia Corporate Pl
Ste A2
Oklahoma City, OK 73142
Phone (405) 752-9600

5101 W Memorial Rd
Oklahoma City, OK 73142
Phone (405) 463-5700

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572480000000",
    "number": "1467495226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268938",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268938",
            "telephone_number": "405-752-9600",
            "fax_number": "405-752-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13921 N MERIDIAN AVE STE 100",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341106",
            "telephone_number": "405-752-9600",
            "fax_number": "405-752-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2019-10-31",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "405-752-9600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kelly Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.