NPIMap

Individual provider Active NPI

Shelly-Ann Benesia Kelly, P.A.

  • Physician Assistant
  • Farmington, CT
National Provider Identifier
1487938361
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
Uconn Medical Group
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-8080
Fax
(860) 679-1430
NPI assigned
Oct 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Surgical Physician Assistant 363AS0400X 002718 CT

Addresses

Primary practice location

Uconn Medical Group
263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

Uconn Medical Group
263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-8080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20120618000014 CT Practitioner - Physician Assistant 2264696509 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bristol Hospital Multi Specialty Group, Inc.Group PAC ID 9032014758, 148 clinicians
Midstate Medical CenterGroup PAC ID 7416840699, 187 clinicians
The Charlotte Hungerford HospitalGroup PAC ID 4486557501, 206 clinicians

Practice addresses (Care Compare)

41 Brewster Rd
Bristol, CT 06010-5161
Phone (860) 585-3000

435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 694-8200

538 Litchfield St
Torrington, CT 06790-6669
Phone (860) 496-6265

540 Litchfield St
Torrington, CT 06790-6679
Phone (860) 496-9669

Hospital & facility affiliations

  • Charlotte Hungerford Hospital Hospital, Torrington, CT, CCN 070011
  • Midstate Medical Center Hospital, Meriden, CT, CCN 070017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002718CTMDHand Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center CurrentSince May 4, 2016 Accepting new patients
The Charlotte Hungerford Hospital CurrentSince Feb 1, 2016 Accepting new patients
University of Connecticut Health Center CurrentSince May 4, 2016 Accepting new patients
Midstate Medical Center CurrentSince Mar 30, 2014 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361

Interoperability endpoints

  • Direct secure messaging: shelly-ann.kelly@xdr.hhchealthdirect.org

Organizations & group practices 8

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 3

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": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1487938361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHELLY-ANN",
        "middle_name": "BENESIA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-10",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "002718",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.