John Robert Kelly, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

181918 Issued in NY

Practice address

357 Genesee Street
Oneida Surgical Group PC
Oneida, NY 13421

Phone

(315) 363-8800

Fax

(315) 363-0103

NPI assigned

Oct 23, 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 7

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkelly12699@mvhealthsystem.direct-ci.com

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.

• Oneida Surgical Group PC

  • Surgery Physician
  • Oneida, NY
  • NPI 1770642902
  Medicare reassignment NPD

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629151949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 GENESEE STREET",
            "city": "ONEIDA",
            "state": "NY",
            "postal_code": "13421",
            "telephone_number": "315-363-8800",
            "fax_number": "315-363-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 GENESEE STREET",
            "address_2": "ONEIDA SURGICAL GROUP PC",
            "city": "ONEIDA",
            "state": "NY",
            "postal_code": "13421",
            "telephone_number": "315-363-8800",
            "fax_number": "315-363-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "181918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "025001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00040192301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF NORTHEASTERN NY",
            "identifier": "00911284001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0100576",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSOURCE HMO NY",
            "identifier": "22160",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "5897089",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01192492",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul M Kardjian, MD
• Daryoosh Karimi-Ardekani, M.D.
• Joseph William Katsarsky, D.M.D.
• Lisa F Keicher, MD
• Christine Kelley, CASAC
• Tatum Kelly
• Christine Kennedy
• Ellyanna Kessler, LMHC
• Jessica Jean Khalid, NP
• Danna Killian

• Surgery Physician in Oneida, NY
• Providers in Oneida, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.