Sandra Kellum, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA10083400 Issued in NJ

Practice address

1401 Avocado Ave Ste 802
Newport Beach, CA 92660-7784

Phone

(949) 644-0970

NPI assigned

Aug 6, 2014

Last updated

Nov 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: sandrakellum@ncmg.allscriptsdirect.net

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.

• Newport Children's Medical Group

  • Primary Care Clinic/Center
  • Newport Beach, CA
  • NPI 1356328330
  NPD (past)

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1669881397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 802",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607784",
            "telephone_number": "949-644-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 802",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607784",
            "telephone_number": "949-644-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "SANDRA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-06",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA10083400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST. JOSEPH'S HEALTHCARE SYSTEM",
            "identifier": "39",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selah Kelley
• Timothy Kelley, MD
• Kelli a. Fox (Golden State Hospice)
• Kelli Junker DDS Inc
• Kelli Junker DDS Inc
• Kelly Kazmierski, PHD, a Psychology Corporation
• Diane G Kelly, LCSW MSW
• Meghan Rose Kelly, FNP-C
• Samantha Bustos Kelly, AUD
• Ruth Kembay

• Pediatrics Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.