NPIMap

Individual provider Active NPI

Kenneth W Kellough, M.D.

  • Internal Medicine Physician
  • Clarksdale, MS
National Provider Identifier
1609815000
Registry record updated Dec 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16776 Issued in MS
Practice address
705 N State St
Clarksdale, MS 38614-6519
Phone
(662) 621-2192
Fax
(662) 621-2314
NPI assigned
Jun 4, 2006
Last updated
Dec 3, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16776 MS Primary

Addresses

Primary practice location

705 N State St
Clarksdale, MS 38614-6519

Mailing address

705 N State St
Clarksdale, MS 38614-6519
Phone (662) 621-2192

Other identifiers 1

IdentifierTypeStateIssuer
00121009MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20040304000139 MS Practitioner - Emergency Medicine 2769379650 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Texas Medical Branch at Galveston, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RH Emergency Medicine of Cleveland LLCGroup PAC ID 4183105232, 14 clinicians

Practice addresses (Care Compare)

901 E Sunflower Rd
Cleveland, MS 38732-2833
Phone (662) 432-4106

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.46 of 100Reported as individual
Quality
70.56
Improvement activities
40
Cost
72.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16776MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
RH Emergency Medicine of Cleveland LLC CurrentSince Feb 1, 2026 Accepting new patients
Acs Emergency Services of Mississippi Professional Association CurrentSince Apr 1, 2014 Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients
Aaron E. Henry Community Health Services Center, Inc Past Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients
Batesville Emergency Physicians Past Accepting new patients
Clarksdale Hma LLC Past Accepting new patients
Clarksdale Hma Physician Management LLC Internal Medicine Past Accepting new patients
T M Carr MD PC Past Accepting new patients

Locations

901 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 846-0061

Interoperability endpoints

  • Direct secure messaging: emy8525@yourcarecommunity.org

Organizations & group practices 12

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 1

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": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259798400000",
    "number": "1609815000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146519",
            "telephone_number": "662-621-2192",
            "fax_number": "662-621-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146519",
            "telephone_number": "662-621-2192",
            "fax_number": "662-621-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOUGH",
        "first_name": "KENNETH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2009-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "16776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121009",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

Verify at the official NPI Registry.