Thomas J Kelly, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

OS6762 Issued in FL

Practice address

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Phone

(850) 863-7607

Fax

(205) 437-5998

NPI assigned

May 4, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AL, FL, MS3 enrollments

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 3

Specialty

Emergency MedicineAlso: Family Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Correct Care, Inc.Group PAC ID 8628980992, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center Enterprise Hospital, Enterprise, AL, CCN 010049
• Tyler Holmes Memorial Hospital Cah Hospital, Winona, MS, CCN 251312
• Washington County Hospital Hospital, Chatom, AL, CCN 011300

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles (20 of 25)

Locations

Networks

• bcbs alabama network 01H0
• bcbs alabama network 01B0
• bcbs alabama network 01A0
• bcbs alabama network 01G0
• bcbs alabama network 01E0

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.

• Correct Care, Inc.

  • Emergency Medicine Physician
  • Covington, LA
  • NPI 1215987441

  AL, MS

  Medicare reassignment Care Compare group NPD
• Emergency Physicians Medical Center LLC

  • Urgent Care Clinic/Center
  • Gainesville, FL
  • NPI 1598908584
  Medicare reassignment NPD
• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment NPD
• Forrest County General Hospital

  • Psychiatric Hospital Unit
  • Hattiesburg, MS
  • NPI 1295837631
  Medicare reassignment NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Montgomery, AL
  • NPI 1437606605
  Medicare reassignment NPD
• Southern Alabama Physicians LLP

  • Emergency Medicine Physician
  • Dothan, AL
  • NPI 1467701490
  Medicare reassignment NPD
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459
  Medicare reassignment
• Emergency Physicians Medical Center, LLC

  • Urgent Care Clinic/Center
  • Gainesville, FL
  • NPI 1861897480

  Emergency Medicine

  NPD
• Forrest County General Hospital

  • Rural Health Clinic/Center
  • Picayune, MS
  • NPI 1043820426
  NPD
• Forrest General Hospital

  • Internal Medicine Physician
  • Hattiesburg, MS
  • NPI 1053512087
  NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Monroeville, AL
  • NPI 1013519230
  NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Sylacauga, AL
  • NPI 1720507635
  NPD

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

• QHG of Enterprise Inc

  • General Acute Care Hospital
  • Enterprise, AL
  • NPI 1720039712
  Care Compare affiliation
• Tyler Holmes Memorial Hospital

  • Critical Access Hospital
  • Winona, MS
  • NPI 1205868627
  Care Compare affiliation
• Washington County Healthcare Authority, Inc

  • Critical Access Hospital
  • Chatom, AL
  • NPI 1487699203
  Care Compare affiliation

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237507200000",
    "number": "1629026596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88452",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606801452",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7607",
            "fax_number": "205-437-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2009-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS6762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "80923",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376379000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "059185641",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "059190499",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George W Keith, DMD
• Sydney CHI-Ann Keith, RBT
• William Kelley, PT
• Kelli L. Parks, OD, LLC
• Kelly Beck, LMHC
• Casey Kennington
• Briana Minette Kent, OTD, OTR/L
• Carla Rena Kersey, OTR/L
• Hannah Elaine Kettle-Church, LPN
• Dawn Kimball Key, LMHC

• Emergency Medicine Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; 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.