Charles E Kelly, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

26263 Issued in MN

Practice address

3050 Centre Pointe Drive
Suite 200
Roseville, MN 55113

Phone

(651) 631-4242

Fax

(651) 631-4260

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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.

• Tomark Physicians PA

  • Physical Medicine & Rehabilitation Physician
  • Sartell, MN
  • NPI 1538259585
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1730123639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 CENTRE POINTE DRIVE",
            "address_2": "SUITE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-639-9150",
            "fax_number": "651-639-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 CENTRE POINTE DRIVE",
            "address_2": "SUITE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-631-4242",
            "fax_number": "651-631-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "26263",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "26263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286577",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elliana Kastner
• Matthew Stuart Kaufenberg, PT
• Bryan Kavanaugh
• KB Nutrition Counseling
• Douglas Kenneth Keim,, D.D.S.
• Lori L Kelly, RN, CNP
• Laura Marie Kelzer, RN
• Robert Bach Kennedy, OD
• Lawrence H Kent, DDS
• Marnie Justine Kerels, RN

• Specialist in Roseville, MN
• Providers in Roseville, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.