Glen David Kelley, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

37410 Issued in CO

Practice address

1001 W Mineral Ave
Littleton, CO 80120-4507

Phone

(303) 334-1100

Fax

(817) 284-3425

NPI assigned

Jul 6, 2011

Sex

Male

Sole proprietor

Yes

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 CO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Healogics Specialty Physicians of Colorado-Professional, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Parker, CO
  • NPI 1114331006

  Physical Medicine & Rehabilitation

  Medicare reassignment NPD
• Healogics Specialty Physicians of Colorado-Professional, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lakewood, CO
  • NPI 1114559572
  NPD

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414800000000",
    "number": "1679860019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678504",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678504",
            "telephone_number": "303-349-0935",
            "fax_number": "817-284-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W MINERAL AVE",
            "city": "LITTLETON",
            "state": "CO",
            "postal_code": "801204507",
            "telephone_number": "303-334-1100",
            "fax_number": "817-284-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "GLEN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-06",
        "last_updated": "2014-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CO",
            "license": "37410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carina Kellenberger, LCSW
• Lisa Gwyn Keller, PA-C
• Jared Kellerman
• Mary M Kelley-Anderle
• Amber Renee Kelley, LMT
• Lisa K. Kelley, LPC
• Mariah Kelley
• Kelsey Kellner, LPCC
• Kelly Howell Counseling LLC
• Blayne Kelly

• Physical Medicine & Rehabilitation Physician in Littleton, CO
• Providers in Littleton, CO by specialty
• Physical Medicine & Rehabilitation Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2014; 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.