NPIMap

Individual provider Active NPI

Kevin Gerard Kelly

  • Family Medicine Physician
  • Russellville, AL
National Provider Identifier
1710972385
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8497 Issued in AL
Practice address
13150 Highway 43
Suite 10
Russellville, AL 35653-4558
Phone
(256) 332-5901
Fax
(256) 332-6911
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 8497 AL Primary

Addresses

Primary practice location

13150 Highway 43
Suite 10
Russellville, AL 35653-4558

Mailing address

13150 Highway 43
Suite 10
Russellville, AL 35653-4558
Phone (256) 332-5901

Other identifiers 1

IdentifierTypeStateIssuer
000001253MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110201000502 AL Practitioner - Family PracticePractitioner - Pediatric Medicine 5294837415 Reassigns benefits to 2 organizations
Receives reassigned benefits from 4 practitioners
Practice locations: Russellville, AL

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Pediatric Medicine
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Russellville Hospital Inc.Group PAC ID 3476878489, 66 clinicians

Practice addresses (Care Compare)

15225 Hwy 43
Suite I
Russellville, AL 35653-1969
Phone (256) 331-2700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Family Wellness, LLC CurrentSince Jan 1, 2026 Accepting new patients
Russellville Hospital Inc Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Russellville Hospital Inc Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Russellville Hospital Inc Past Accepting new patients
Franklin LTC, LLC Past Accepting new patients
Burns Nursing Home, Inc. Past Accepting new patients

Locations

530 Bexar Ave W
Hamilton, AL 35570
Phone (205) 269-1483

15225 Highway 43
Ste I
Russellville, AL 35653
Phone (256) 331-2700

13150 Highway 43
Ste 10
Russellville, AL 35653
Phone (256) 331-2092

Networks

  • bcbs alabama network 01C0
  • bcbs alabama network 01B0
  • bcbs alabama network 01G0
  • bcbs alabama network 01E0
  • bcbs alabama network 01H0

Interoperability endpoints

  • Direct secure messaging: kevingkellymd.kevinkelly@124705.advancedmd-direct.com
  • Direct secure messaging: kevin.kelly@russ.eclinicaldirectplus.com
  • FHIR API: https://fhir.yourcareuniverse.net/tenant/15210b52-659d-4e08-a38d-3a74b25af386

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Terrace Manor Nursing & Rehabilitation CenterRussellville, AL, CCN 015066 Skilled nursing facility Adp of the SNF May 14, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395964800000",
    "number": "1710972385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13150 HIGHWAY 43",
            "address_2": "SUITE 10",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356534558",
            "telephone_number": "256-332-5901",
            "fax_number": "256-332-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13150 HIGHWAY 43",
            "address_2": "SUITE 10",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356534558",
            "telephone_number": "256-332-5901",
            "fax_number": "256-332-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "GERARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2014-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "8497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001253",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AL

Sources for this page

Verify at the official NPI Registry.