Active NPI
John Kelly, M.D.
- Emergency Medicine Physician
- Burlington, MA
National Provider Identifier
1629169719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 42899
- Practice address
- Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001 - Phone
- (781) 744-8100
- Fax
- (781) 744-5659
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 42899 | MA | Primary |
Addresses
Primary practice location
Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001
Mailing address
Lahey Clinic
41 Mall Road
Burlington, MA 01805-0001
Phone (781) 744-8100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2063778 | Medicaid | MA | |
| 110037828A | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42899 | MA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lahey Clinic, Inc. | Past | Accepting new patients | |
| Lahey Clinic, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
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- Peabody, MA
- NPI 1063447316
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289865600000",
"number": "1629169719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "LAHEY CLINIC",
"address_2": "41 MALL ROAD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018050001",
"telephone_number": "781-744-8100",
"fax_number": "781-744-5659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LAHEY CLINIC",
"address_2": "41 MALL ROAD",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018050001",
"telephone_number": "781-744-8100",
"fax_number": "781-744-5659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOHN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2010-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MA",
"license": "42899",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2063778",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110037828A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.