Aubrey Derrick Kelly

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A196958 Issued in CA

Practice address

924 Westwood Blvd Ste 300
Los Angeles, CA 90024-2924

Phone

(310) 794-0785

NPI assigned

Apr 13, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of California, Geffen School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital - West la Hospital, Los Angeles, CA, CCN 050561

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment Care Compare group
• Grand Avenue Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Bakersfield, CA
  • NPI 1962913632
  Medicare reassignment NPD
• Regents of the Univ of Ca Emer Med

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1104889138
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Los Angeles, CA
  • NPI 1043242563
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1134274897
  Care Compare affiliation

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1730822206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 WESTWOOD BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900242924",
            "telephone_number": "310-794-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 WESTWOOD BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900242924",
            "telephone_number": "310-794-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "AUBREY",
        "middle_name": "DERRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-13",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A196958",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "114493",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antoinette Kellum
• Kelly Ho, D.D.S.
• Angel Rene Kelly-Blaydes, MSW
• Samantha Kelly-Latzer
• Alison Scott Kelly, M.S., R.D.
• Brenna Michelle Kelly
• Carol Ann Kelly, ED.D.
• Christina Ann Kelly
• El'Lina Janay Kelly
• Emma Kelly

• Emergency Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.