Individual provider Active NPI

William P Kelly, D.C.

  • Chiropractor
  • Tecumseh, MI
National Provider Identifier
1689736159
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301009278 Issued in MI
Practice address
105 S Pearl St
Tecumseh, MI 49286-1951
Phone
(517) 423-3600
Fax
(517) 423-1452
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301009278 MI Primary

Addresses

Primary practice location

105 S Pearl St
Tecumseh, MI 49286-1951

Mailing address

2900 Packard Rd
Ste 2
Ypsilanti, MI 48197-2061
Phone (734) 677-0111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141023002346 MI Practitioner - Chiropractic 5890916480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jason J Hesselberg DC PLLCGroup PAC ID 6800040338, 3 clinicians

Practice addresses (Care Compare)

2900 Packard Rd
Suite 2
Ypsilanti, MI 48197-2061
Phone (734) 677-0111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jason J. Hesselberg DC PLLC Chiropractor CurrentSince Sep 16, 2014 Accepting new patients
Sean T Edison PC Chiropractor PastSince Jun 1, 2000 Accepting new patients

Locations

2900 Packard Rd
Ste 2
Ypsilanti, MI 48197
Phone (734) 677-0111

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1689736159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 PACKARD RD",
            "address_2": "STE 2",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972061",
            "telephone_number": "734-677-0111",
            "fax_number": "734-677-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S PEARL ST",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492861951",
            "telephone_number": "517-423-3600",
            "fax_number": "517-423-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "WILLIAM",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tecumseh, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.