Michael D Kelley, MD
Individual provider Active NPI Emergency Medicine Physician · Evansville, IN
NPI 1700980265 · NPPES record last updated Aug 21, 2012
Key facts
- NPI
- 1700980265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 01054744A (IN)
- Practice address
- 600 Mary St
Evansville, IN 47747-0001 - Phone
- (812) 450-3405
- Fax
- (812) 450-3099
- NPI assigned
- Sep 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Texas a & M University System, HSC, College of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DHHS PHS Naihs Crownpoint Hospital
Practice addresses (Care Compare)
Junction of Hwy 371 Navajo RT 9
Crownpoint, NM 87313-0358
Phone (505) 786-5291
Hospital & facility affiliations
- Crownpoint Healthcare Facility
- Gallup Indian Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 78.18 of 100
- Quality
- 61.12
- Improvement activities
- 40
- Cost
- 81.87
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140222000281 | TX | Practitioner - Emergency Medicine | 8921130014 | Reassigns benefits to 2 organizations |
| I20230310000826 | AZ | Practitioner - Emergency Medicine | 8921130014 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS,PHS,Naihs, Gallup Indian Medical Center | Current |
Accepting new patients | |
| Pueblo Pintado Clinic | Current |
Accepting new patients | |
| Thoreau Clinic | Current |
Accepting new patients | |
| Northwest HBP Medical Services LLC | Emergency Medicine | Current |
Accepting new patients |
| Progressive Medical Associates PLLC | Emergency Medicine | Current |
Accepting new patients |
| DHHS PHS Naihs Crownpoint Hospital | Current | Accepting new patients |
Locations
1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000
6200 N La Cholla Blvd
Tucson, AZ 85741
Phone (520) 229-2657
516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326
5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01054744A | IN | Yes |
Addresses
Primary practice location
600 Mary St
Evansville, IN 47747-0001
Mailing address
PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-6815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000381080 | Other | IN | BCBS - GATEWAY |
| 076673 | Other | IN | HAMP # |
| 7127259 | Other | IN | AETNA # |
| 000000212792 | Other | IN | BCBS - MARY STREET |
| 200353450 | Medicaid | IN | |
| 1973034 | Other | IN | FIRST HEALTH # |
| 470324 | Other | IN | HEALTHLINK # |
| 64036205 | Medicaid | KY |
Other providers in Evansville, IN
- Kathalene E Keller Riney
- Miranda Gail Keller
- Janet Marie Kelley
- Jennifer L Kelley
- Jennifer N Kelley
- Tracey D Kelley
- Emily Claire Kellner
- Brian P Kelly
- Kelly Kelly
- Sydney M Kelly
All providers in Evansville, IN · Emergency Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.