Timothy P Kelley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001000651 Issued in NC

Practice address

202 Williamson Rd Ste 100
Mooresville, NC 28117-7610

Phone

(704) 799-7811

Fax

(704) 799-7812

NPI assigned

Oct 18, 2006

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

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.kelley.1@29681.direct.athenahealth.com
• Direct secure messaging: tkelley35167@fastmed.direct-ci.com
• Direct secure messaging: tim.kelley.1@4693.direct.athenahealth.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.

• Avance Care, PA

  • Clinic/Center
  • Fuquay Varina, NC
  • NPI 1487845020
  Medicare reassignment Care Compare group
• Mooresville PPM LLC

  • Family Medicine Physician
  • Mooresville, NC
  • NPI 1861769119
  NPD
• Carolinas Physicians Network Inc

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1386653830
  NPD (past)
• Carolinas Physicians Network Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD (past)
• Carolinas Physicians Network Inc

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1437168937
  NPD (past)
• Carolinas Physicians Network Inc

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1497762686
  NPD (past)
• Carolinas Physicians Network Inc

  • Family Medicine Physician
  • Concord, NC
  • NPI 1902049190
  NPD (past)
• Union Urgent Care LLC

  • Family Medicine Physician
  • Indian Trail, NC
  • NPI 1659380079
  NPD (past)
• Presence Service Corporation

  • Family Medicine Physician
  • Bolingbrook, IL
  • NPI 1831204536
  NPD (past)

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

• Hoag Memorial Hospital Presbyterian

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1518951300
  Care Compare affiliation

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1679654057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 WILLIAMSON RD",
            "address_2": "STE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177610",
            "telephone_number": "704-799-7811",
            "fax_number": "704-799-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 WILLIAMSON RD STE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177610",
            "telephone_number": "704-799-7811",
            "fax_number": "704-799-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "TIMOTHY",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001000651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679654057",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101237",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085001277",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tim.kelley.1@4693.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct access",
            "address_1": "202 Williamson Rd Ste 100",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281177610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Justin Kauffman, DDS
• KDW Chirocare Inc
• John Scott Keadle, DDS
• Natasha Lynette Kearney, CCC SLP
• Conor Keeley
• Ingrid Kenron
• Victoria Henderson Kepley, AGNP
• Elizabeth Verdery Kerr
• Kerry L. Musick, MD, PLLC
• Ervin Vincent Ketchie, LPC

• Physician Assistant in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.