Jeffrey Glen Kelly Sr.

Primary specialty

Adult CompanionTaxonomy code 372600000X

Practice address

3440 Viking Dr
Sacramento, CA 95827-2844

Phone

(916) 262-8598

NPI assigned

Dec 19, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• County of Sacramento

  • Radiology Clinic/Center
  • Sacramento, CA
  • NPI 1508936030
  NPD (past)

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1508338294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 VIKING DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272844",
            "telephone_number": "916-262-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 VIKING DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272844",
            "telephone_number": "916-262-8598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 M St",
            "address_purpose": "LOCATION",
            "city": "Rio Linda",
            "state": "CA",
            "postal_code": "956732218",
            "country_code": "US",
            "telephone_number": "916-287-4067",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7415 Henrietta Dr",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958225142",
            "country_code": "US",
            "telephone_number": "916-520-7399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JEFFREY",
        "middle_name": "GLEN",
        "name_suffix": "Sr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-19",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana D Kelly, CADCLL
• Deirdra Kelly
• James Kelly, PTA
• James Kelly
• Janaya Grace Kelly, CADC II
• Jennifer R. Kelly, FNP-C
• Julie C. Kelly, MSW
• Karen Kelly, M.D.
• Karessa J Kelly, LMFT
• Kiersten Kelly, MD

• Adult Companion in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Adult Companion in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; 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.