Kelly B Fandel, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

40924 Issued in MN

Practice address

1900 Centracare Circle
Centracare Clinic - Womens & Childrens
St Cloud, MN 56303-5000

Phone

(320) 654-3630

NPI assigned

Jun 18, 2006

Sex

Female

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 1

Other names 1

• Kelly Flanagan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12435/brand/1/csg/1/fhir/r4
• Direct secure messaging: kelly.fandel.1@33161.direct.athenahealth.com

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.

• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Joseph, MN
  • NPI 1134121759
  NPD (past)
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1225030844
  NPD (past)
• Sartell Pediatrics, P.a.

  • Pediatrics Physician
  • Sartell, MN
  • NPI 1215203898
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219795200000",
    "number": "1487699179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIRCLE",
            "address_2": "CENTRACARE CLINIC - WOMENS & CHILDRENS",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIRCLE",
            "address_2": "CENTRACARE CLINIC - WOMENS & CHILDRENS",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANDEL",
        "first_name": "KELLY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "40924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372219800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "FLANAGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eye Surgeons & Physicians PA
• Sara Elizabeth Faber, PHARMD
• Richard Michael Fagerness, RPH
• Oluwatobi Olushoga Falade, MBBS
• Thomas B Falloon, MD
• Elle Faodail
• Amina Farah
• Ayan Abdi Farah
• Barwaqo Muhidin Farah
• Bisharo M Farah

• Pediatrics Physician in St Cloud, MN
• Providers in St Cloud, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.