NPIMap

Individual provider Active NPI

Ralph Zane Kelley, DO

  • Surgery Physician
  • Flagstaff, AZ
National Provider Identifier
1538369384
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
005754 Issued in AZ
Practice address
77 W Forest Ave Ste 206
Flagstaff, AZ 86001-1483
Phone
(239) 980-4302
Fax
(928) 773-2598
NPI assigned
Jul 20, 2007
Last updated
Apr 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X DO1481 NV
Surgery Physician 208600000X 005754 AZ Primary

Addresses

Primary practice location

77 W Forest Ave Ste 206
Flagstaff, AZ 86001-1483

Mailing address

PO Box 600
Tuba City, AZ 86045-0600
Phone (928) 283-2501

Other identifiers 4

IdentifierTypeStateIssuer
3218514OtherAZCIGNA
540447MedicaidAZ
1538369384OtherAZUHC
1538369384OtherAZBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110815000891 TX Practitioner - General Surgery 1052437811 Reassigns benefits to 1 organization
I20120420000595 AZ Practitioner - General Surgery 1052437811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flagstaff Surgical Associates PAGroup PAC ID 6901880210, 32 clinicians

Practice addresses (Care Compare)

167 Main St
Tcrhcc Mobile Medical Clinic
Tuba City, AZ 86045-0600
Phone (928) 283-2501

77 W Forest Ave
Suite 201
Flagstaff, AZ 86001-1483
Phone (928) 773-2222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy18
Upper gastrointestinal (GI) endoscopy for acid reflux23
Removal of tissue11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
005754AZMDSurgery Physician
DO1481NVMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Surgery Current Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Jul 18, 2011 Accepting new patients
Lechee Health Facility CurrentSince Jul 18, 2011 Accepting new patients
Tuba City Regional Health Care Corporation Surgery Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1538369384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W FOREST AVE STE 206",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011483",
            "telephone_number": "239-980-4302",
            "fax_number": "928-773-2598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "RALPH",
        "middle_name": "ZANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-20",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "DO1481",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "005754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3218514",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540447",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1538369384",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1538369384",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.