NPIMap

Individual provider Active NPI

Kelly Roden, MD

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1730538513
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R5198 Issued in TX
Practice address
11937 US Highway 271
Tyler, TX 75708-3154
Phone
(903) 877-7200
NPI assigned
Jun 13, 2016
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BP10057148 TX
Family Medicine Physician 207Q00000X R5198 TX Primary

Addresses

Primary practice location

11937 US Highway 271
Tyler, TX 75708-3154

Mailing address

PO Box 731912
Dallas, TX 75373-1912
Phone (903) 877-7200

Other names 1

  • Kelly Hutton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180806000776 TX Practitioner - Family Practice 8820380801 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nocona Hospital DistrictGroup PAC ID 5395786180, 23 clinicians
Nocona Medical Clinic, P.a.Group PAC ID 3072661354, 4 clinicians

Practice addresses (Care Compare)

100 Park Rd
Nocona, TX 76255-3616
Phone (940) 825-3235

90 Park Rd
Nocona, TX 76255-3600
Phone (940) 825-3333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nocona Hospital District Family Medicine CurrentSince Sep 1, 2019 Accepting new patients
Nocona Medical Clinic, P.a. Family Medicine CurrentSince Sep 1, 2019 Accepting new patients
Nocona Hospital District CurrentSince Sep 1, 2019 Accepting new patients
Texas Spine and Joint Hospital, LLC CurrentSince Sep 28, 2018 Accepting new patients
Nocona Hospital District Current Accepting new patients
Nocona Hospital District Past Accepting new patients
Plano Healthcare Residence Operator LLC Past Accepting new patients
Nocona Hospital District Past Accepting new patients
Nocona Hospital District Past Accepting new patients

Locations

100 Park Rd
Nocona, TX 76255
Phone (940) 825-3235

90 Park Rd
Nocona, TX 76255
Phone (940) 825-3333

1814 Roseland Blvd
Tyler, TX 75701
Phone (903) 525-3300

1814 Roseland Blvd
Ste 100
Tyler, TX 75701
Phone (214) 696-8033

1814 Roseland Blvd
Ste 210
Tyler, TX 75701
Phone (903) 525-3300

Organizations & group practices 9

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 10

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": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1730538513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731912",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753731912",
            "telephone_number": "903-877-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODEN",
        "first_name": "KELLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10057148",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R5198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HUTTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.