Michael W. Kelly, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

7061 Issued in SC

Practice address

200 Patewood Dr
Suite B200
Greenville, SC 29615-3593

Phone

(864) 232-7338

Fax

(864) 239-6645

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Greenville Proaxis Therapy, LLC

  • Physical Therapist
  • Greenville, SC
  • NPI 1669457859
  NPD (past)
• New Horizon Family Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Greenville, SC
  • NPI 1629872734
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306108800000",
    "number": "1720171309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 8676",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296048676",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE B200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "7061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070611",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debbie S Kelly, CRNA
• Desmond Peyton Kelly, M.D.
• John William Kelly, M.D.
• Kevin Michael Kelly
• Martha Kelly, MCSD, CCC-SLP
• Misti Lorrain Kelly, RN
• Omni Kelly
• Rebecca Collins Kelly, PT
• Mark Allen Kemble, M.D.
• Richard Wayne Kemmerlin, MD

• All providers in Greenville, SC
• Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.