NPIMap

Individual provider Active NPI

Ralph Kelley, DO

  • Adult Medicine Physician
  • Portageville, MO
National Provider Identifier
1669589677
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
31361 Issued in MO
Practice address
314 E Main St
Portageville, MO 63873-1616
Phone
(573) 379-3777
NPI assigned
Aug 24, 2006
Last updated
Dec 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 31361 MO Primary

Addresses

Primary practice location

314 E Main St
Portageville, MO 63873-1616

Mailing address

314 E Main St
Portageville, MO 63873-1616
Phone (573) 379-3777

Other identifiers 1

IdentifierTypeStateIssuer
241143213MedicaidMO

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 Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care St. Louis Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot Memorial Health Systems Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1669589677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 E MAIN ST",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638731616",
            "telephone_number": "573-379-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 E MAIN ST",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638731616",
            "telephone_number": "573-379-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "RALPH",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "31361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241143213",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portageville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.