NPIMap

Individual provider Active NPI

Jay Ross Connelley, M.D.

  • Family Medicine Physician
  • Monticello, AR
National Provider Identifier
1649250689
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C8242 Issued in AR
Practice address
777 Jordan Dr
Monticello, AR 71655-5719
Phone
(870) 723-4921
NPI assigned
Jan 17, 2006
Last updated
Apr 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C8242 AR Primary

Addresses

Primary practice location

777 Jordan Dr
Monticello, AR 71655-5719

Mailing address

PO Box 417
Monticello, AR 71657-0417
Phone (870) 460-9001

Other identifiers 4

IdentifierTypeStateIssuer
128888001MedicaidAR
178800000OtherARQUALCHOICE
80133356OtherARTRAVERLERS RAILROAD
77007401OtherARBREASTCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20060117001167 AR Practitioner - Family Practice 4284658295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1222 Old Warren Rd
Suite a
Monticello, AR 71655-5041
Phone (870) 460-9001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions40
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C8242ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connelley Family Medical, PLLC Family Medicine CurrentSince Nov 15, 2018 Accepting new patients

Locations

1222 Old Warren Rd
Ste A
Monticello, AR 71655
Phone (870) 460-9001

777 Jordan Dr
Monticello, AR 71655
Phone (870) 460-9001

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CHCGBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/CHCGBD/Endpoint/CHCGBD

Organizations & group practices 1

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 8

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1649250689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716570417",
            "telephone_number": "870-460-9001",
            "fax_number": "870-412-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 JORDAN DR",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555719",
            "telephone_number": "870-723-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLEY",
        "first_name": "JAY",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C8242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128888001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "178800000",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVERLERS RAILROAD",
            "identifier": "80133356",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREASTCARE",
            "identifier": "77007401",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, AR

Sources for this page

Verify at the official NPI Registry.