NPIMap

Individual provider Active NPI

Richard Adam Kellis, MD

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1497040836
Registry record updated Jun 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MT200418 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4206
Phone
(215) 662-8777
NPI assigned
Jun 14, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT200418 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X MT200418 PA

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4206
Phone (215) 662-8777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20170908002574 OR Practitioner - Family Practice 1052633443 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tuality Medical Group LLCGroup PAC ID 7416173414, 289 clinicians

Practice addresses (Care Compare)

335 SE 8TH Ave
Hillsboro, OR 97123-4246
Phone (503) 681-1111

Hospital & facility affiliations

  • Amedisys Home Health Care Home health agency, Portland, OR, CCN 387003
  • Hillsboro Medical Center Hospital, Hillsboro, OR, CCN 380021
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT200418PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Health & Science University CurrentSince Nov 1, 2020 Accepting new patients
Tuality Medical Group LLC CurrentSince Jan 27, 2018 Accepting new patients
Tuality Healthcare CurrentSince Jan 27, 2018 Accepting new patients
Oregon Health & Science University Current Accepting new patients
Tuality Medical Group LLC CurrentSince Dec 1, 2024 Accepting new patients
University Professional Services CurrentSince Sep 18, 2017 Accepting new patients
University Professional Services Current Accepting new patients
University Professional Services CurrentSince Sep 18, 2017 Accepting new patients
Tuality Healthcare CurrentSince Jan 27, 2018 Accepting new patients
Oregon Health & Science University CurrentSince Nov 1, 2020 Accepting new patients
Tuality Healthcare Family Medicine Current Accepting new patients
Tuality Healthcare Current Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

6355 NE Cornell Rd
Ste 100
Hillsboro, OR 97124
Phone (503) 597-3130

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

3930 SE Division St
Portland, OR 97202
Phone (503) 418-3900

Interoperability endpoints

  • Direct secure messaging: rkellis103551@direct.ohsu.edu

Organizations & group practices 12

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1497040836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLIS",
        "first_name": "RICHARD",
        "middle_name": "ADAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT200418",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT200418",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.