NPIMap

Individual provider Active NPI

Rebecca H Kelly, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Indianapolis, IN
National Provider Identifier
1740385525
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
01028621A Issued in IN
Practice address
7250 Clearvista Dr
Suite 327a
Indianapolis, IN 46256-4692
Phone
(317) 621-7390
Fax
(317) 621-4494
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X 01028621A IN Primary

Addresses

Primary practice location

7250 Clearvista Dr
Suite 327a
Indianapolis, IN 46256-4692

Mailing address

7250 Clearvista Dr
Suite 327a
Indianapolis, IN 46256-4692
Phone (317) 621-7390

Other identifiers 3

IdentifierTypeStateIssuer
000000809673OtherINANTHEM
4352781OtherINAETNA BEHAVIORAL HEALTH
000000810128OtherINANTHEM

Other names 1

  • Rebecca J Hartsock Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairbanks Hospital, Inc. Addiction Medicine Current Accepting new patients
Community Health Network, Inc Past Accepting new patients
Major Hospital Past Accepting new patients
Community Health Network, Inc. Past Accepting new patients
Serenity Medical Center West LLC PastSince Jan 1, 2012 Accepting new patients
Serenity Medical Center LLC PastSince Jan 1, 2011 Accepting new patients

Locations

8102 Clearvista Pkwy
Indianapolis, IN 46256
Phone (317) 572-9319

Interoperability endpoints

  • Direct secure messaging: rkelly61856@ecommunitydirect.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1740385525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 CLEARVISTA DR",
            "address_2": "SUITE 327A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564692",
            "telephone_number": "317-621-7390",
            "fax_number": "317-621-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 CLEARVISTA DR",
            "address_2": "SUITE 327A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564692",
            "telephone_number": "317-621-7390",
            "fax_number": "317-621-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "REBECCA",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "IN",
            "license": "01028621A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000809673",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BEHAVIORAL HEALTH",
            "identifier": "4352781",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000810128",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "HARTSOCK",
            "middle_name": "J",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.