NPIMap

Individual provider Active NPI

Amy Marie Kelly, DO

  • Family Medicine Physician
  • Saint Marys, PA
National Provider Identifier
1578797668
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OT013046 Issued in PA
Practice address
757 Johnsonburg Rd
Suite 100
Saint Marys, PA 15857-3488
Phone
(814) 788-8580
Fax
(814) 788-8018
NPI assigned
May 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OT013046 PA Primary

Addresses

Primary practice location

757 Johnsonburg Rd
Suite 100
Saint Marys, PA 15857-3488

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-6560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20120618000562 PA Practitioner - Family Practice 2769646058 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

145 Hospital Ave
Suite 315
Du Bois, PA 15801-1465
Phone (814) 503-4305

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

757 Johnsonburg Rd
Saint Marys, PA 15857-3488

761 Johnsonburg Rd
Saint Marys, PA 15857-3480
Phone (814) 788-8220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT013046PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Center Family Medicine CurrentSince Mar 31, 2014 Accepting new patients
Brookville Hospital Family Medicine CurrentSince Oct 1, 2020 Accepting new patients
Dubois Regional Medical Center CurrentSince Mar 31, 2014 Accepting new patients
Brookville Hospital Family Medicine CurrentSince Oct 1, 2020 Accepting new patients
Dubois Regional Medical Center Past Accepting new patients

Locations

100 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1408

88 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1874

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

145 Hospital Ave
Ste 101
Dubois, PA 15801
Phone (814) 375-5305

416 N Broad St
Emporium, PA 15834
Phone (814) 486-2202

275 E 4th St
Emporium, PA 15834
Phone (814) 486-6123

111 Cobb St
Johnsonburg, PA 15845
Phone (814) 965-2857

271 Railroad St
Philipsburg, PA 16866
Phone (814) 342-1872

763 Johnsonburg Rd
Saint Marys, PA 15857
Phone (814) 788-8000

757 Johnsonburg Rd
Ste 110
Saint Marys, PA 15857
Phone (814) 788-8580

757 Johnsonburg Rd
Ste 100
Saint Marys, PA 15857
Phone (814) 788-2343

Organizations & group practices 6

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 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1241481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1578797668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-375-6560",
            "fax_number": "814-372-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 JOHNSONBURG RD",
            "address_2": "SUITE 100",
            "city": "SAINT MARYS",
            "state": "PA",
            "postal_code": "158573488",
            "telephone_number": "814-788-8580",
            "fax_number": "814-788-8018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-05",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT013046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Marys, PA

Sources for this page

Verify at the official NPI Registry.