NPIMap

Organization Active NPI

William M. Kelly M.D., Inc.

  • Diagnostic Neuroimaging (Radiology) Physician
  • Lake Elsinore, CA
National Provider Identifier
1497069660
Registry record updated Aug 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Radiology) PhysicianTaxonomy code 2085D0003X
License
A34125 Issued in CA
Legal business name
WILLIAM M. KELLY M.D., INC.
Practice address
425 Diamond Dr
Suite 103
Lake Elsinore, CA 92530-4495
Phone
(951) 245-2700
Fax
(951) 245-2770
NPI assigned
Jul 30, 2010
Organization subpart
Yes
Parent organization
WILLIAM M. KELLY M.D., INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2010

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

Authorized official

Name
Dr. William M. Kelly, M.D.
Title
President
Phone
(760) 776-8001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Radiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085D0003X A34125 CA Primary

Addresses

Primary practice location

425 Diamond Dr
Suite 103
Lake Elsinore, CA 92530-4495

Mailing address

44489 Town Center Way
Suite D Box 540
Palm Desert, CA 92260-2723
Phone (760) 776-9777

Other names 1

  • Health Scan Imaging Doing business as

National Provider Directory

National Provider Directory
Tax ID family
William M Kelly MD Inc10 organizations share this tax ID, including this one
Part of
William M Kelly MD Inc

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280880000000",
    "number": "1497069660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44489 TOWN CENTER WAY",
            "address_2": "SUITE D BOX 540",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922602723",
            "telephone_number": "760-776-9777",
            "fax_number": "760-776-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 DIAMOND DR",
            "address_2": "SUITE 103",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304495",
            "telephone_number": "951-245-2700",
            "fax_number": "951-245-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM M. KELLY M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM M. KELLY M.D., INC.",
        "enumeration_date": "2010-07-30",
        "last_updated": "2010-08-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-776-8001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085D0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "CA",
            "license": "A34125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Scan Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; 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.