Mark Kim Kelly, M.D

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301095025 Issued in MI

Practice address

3707 New Vision Dr
Fort Wayne, IN 46845-1702

Phone

(248) 787-4905

NPI assigned

Aug 4, 2009

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

Medicare fee-for-service enrollment

Enrolled in IN, OH2 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 2

Specialty

Diagnostic Radiology

Education

Wayne State University School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fort Wayne Radiology Associates LLCGroup PAC ID 5294624060, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121
• Parkview Wabash Hospital, Inc Hospital, Wabash, IN, CCN 151310
• Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101
• Parkview Noble Hospital Hospital, Kendallville, IN, CCN 150146

Merit-based Incentive Payment System (MIPS)

Final score

80.28 of 100Reported as group

Quality

77.29

Improvement activities

40

Cost

73.88

Merit-based Incentive Payment System (MIPS)

Final score

85.81 of 100Reported as group

Quality

80.59

Promoting interoperability

100

Improvement activities

40

Cost

72.11

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkelly86798@direct.parkviewexchange.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.

• Fort Wayne Radiology Associates LLC

  dba Dexa Diagnostics

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
  • NPI 1063475861

  OH

  Medicare reassignment Care Compare group NPD
• P E T Imaging Services LLC

  dba P.E.T. Fusion

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
  • NPI 1992768691
  Medicare reassignment NPD
• Community Hospitals and Wellness Centers

  • General Practice Physician
  • Bryan, OH
  • NPI 1225167893
  NPD
• Community Hospitals and Wellness Centers

  • Medicare Defined Swing Bed Hospital Unit
  • Montpelier, OH
  • NPI 1386687218
  NPD
• Breast Diagnostic Center, LLC

  dba Breast Diagnostic Screening Center, LLC

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
  • NPI 1790748499
  NPD (past)
• Summit Radiology P C

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
  • NPI 1073584587
  NPD (past)

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

• Community Hospital of Noble County, Inc.

  dba Parkview Noble Hospital

  • General Acute Care Hospital
  • Kendallville, IN
  • NPI 1457366189
  Care Compare affiliation
• Parkview Hospital, Inc.

  dba Parkview Regional Medical Center

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• Parkview Wabash Hospital, Inc.

  dba Parkview Wabash Hospital

  • Critical Access Hospital
  • Wabash, IN
  • NPI 1245259878
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  dba Parkview Whitley Hospital

  • General Acute Care Hospital
  • Columbia City, IN
  • NPI 1205844495
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  dba Parkview Whitley Hospital

  • Land Ambulance
  • Columbia City, IN
  • NPI 1497764450

  Hospital

  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • General Acute Care Hospital
  • Bryan, OH
  • NPI 1962458521
  Care Compare affiliation

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453852800000",
    "number": "1639300932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451702",
            "telephone_number": "248-787-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451702",
            "telephone_number": "248-787-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARK",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2016-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301095025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Burke, LLC (Insight Counseling)
• Kathryn Kelly Rethlake
• Crystal Kelly, MS
• Kevin J Kelly, MD
• Margaret Kelly, O.T.
• Tammi L Kelpin, LMT, RN
• Veantrea Lachette Kelsaw, QMA,CNA
• Charles Lamoine Kelsey, D. C.
• Vicki Kelsey, D. C.
• Emily Keltner, MA, ACSM-CEP

• Diagnostic Radiology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.