Active NPI
Jeffery S Kelley MD
- Internal Medicine Physician
- Jay, FL
National Provider Identifier
1689933467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME81689
- Legal business name
- JEFFERY S KELLEY MD
- Practice address
- 14088 Alabama St
Jay, FL 32565-1036 - Phone
- (850) 675-4546
- Fax
- (850) 675-4548
- NPI assigned
- May 14, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffery Scott Kelley, MD
- Title
- Owner/President
- Phone
- (850) 675-4546
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME81689 | FL | Primary |
Addresses
Primary practice location
14088 Alabama St
Jay, FL 32565-1036
Mailing address
PO Box 10
Jay, FL 32565-0010
Phone (850) 675-4546
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009952450 | Other | AL | ALACAID |
| 7032394 | Other | AETNA | |
| 59037346 | Other | BLUE CROSS AND BLUE SHIELD OF ALABAMA | |
| 591032244 | Other | CHAMPVA | |
| P00017883 | Other | RAILROAD MEDICARE | |
| 261059100 | Medicaid | FL | |
| 4071564 | Other | CIGNA | |
| A611 | Other | WELLCARE | |
| 05101 | Other | BLUE CROSS AND BLUE SHIELD OF FLORIDA | |
| 1203400 | Other | COVENTRY | |
| 2239990 | Other | UNITED HEALTHCARE | |
| 591032244 | Other | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121102000391 | FL | Part B Supplier - Clinic/Group Practice | 7911158712 |
Receives reassigned benefits from 1 practitioner Practice locations: Jay, FL |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Acute Care Nurse Practitioner
- Milton, FL
- NPI 1255708459
-
- Family Medicine Physician
- Jay, FL
- NPI 1477559409
-
- Family Medicine Physician
- Bradenton, FL
- NPI 1881191708
-
- Family Medicine Physician
- Jay, FL
- NPI 1871546515
-
- Family Medicine Physician
- Jay, FL
- NPI 1497710313
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336953600000",
"number": "1689933467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10",
"city": "JAY",
"state": "FL",
"postal_code": "325650010",
"telephone_number": "850-675-4546",
"fax_number": "850-675-4548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14088 ALABAMA ST",
"city": "JAY",
"state": "FL",
"postal_code": "325651036",
"telephone_number": "850-675-4546",
"fax_number": "850-675-4548"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JEFFERY S KELLEY MD",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-14",
"last_updated": "2012-05-14",
"status": "A",
"authorized_official_last_name": "KELLEY",
"authorized_official_first_name": "JEFFERY",
"authorized_official_middle_name": "SCOTT",
"authorized_official_title_or_position": "OWNER/PRESIDENT",
"authorized_official_telephone_number": "850-675-4546",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME81689",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALACAID",
"identifier": "009952450",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7032394",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIELD OF ALABAMA",
"identifier": "59037346",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPVA",
"identifier": "591032244",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00017883",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "261059100",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4071564",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "A611",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIELD OF FLORIDA",
"identifier": "05101",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "1203400",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2239990",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "591032244",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.