Nathaniel Justin Kelly, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD209942 Issued in OR

Practice address

500 SW Ramsey
Grants Pass, OR 97527

Phone

(541) 472-7000

Fax

(513) 686-6868

NPI assigned

Apr 16, 2019

Reactivated

Jan 3, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002
• Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Asante Physician Partners

  • Family Medicine Physician
  • Medford, OR
  • NPI 1922381326

  Internal Medicine

  Medicare reassignment Care Compare group NPD

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

• Asante

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1770587107
  Care Compare affiliation
• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation

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

{
    "created_epoch": "1555372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1548823552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SW RAMSEY",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97527",
            "telephone_number": "541-472-7000",
            "fax_number": "513-686-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SW RAMSEY",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97527",
            "telephone_number": "541-472-7000",
            "fax_number": "513-686-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NATHANIEL",
        "middle_name": "JUSTIN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-16",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "deactivation_date": "2019-12-04",
        "reactivation_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD209942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eun Keith
• Heidi Kelley
• Pamela Dee Kelley
• Daniel E Kellogg, CADC - R
• Caroline Lansing Kelly, MD
• Lisa Mary Kelz, RN-BSN
• Warren Kendall, M.D.
• Lisa Kennedy
• Katherine J Kent, MSW, LCSW
• Sarah Keppinger

• Internal Medicine Physician in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.