NPIMap

Individual provider Active NPI

Brent L Kelley, M.D.

  • Family Medicine Physician
  • Hayward, WI
National Provider Identifier
1750306288
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39957 Issued in WI
Practice address
15954 Rivers Edge Dr
Hayward, WI 54843-7800
Phone
(715) 634-2541
Fax
(715) 634-5740
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39957 WI Primary

Addresses

Primary practice location

15954 Rivers Edge Dr
Hayward, WI 54843-7800

Mailing address

15735 W US Highway 63
Hayward, WI 54843-6475
Phone (888) 834-4551

Other identifiers 1

IdentifierTypeStateIssuer
30086600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20101117000896 WI Practitioner - Family Practice 3870788730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Lakes Community Health Center IncGroup PAC ID 0840366654, 104 clinicians

Practice addresses (Care Compare)

15954 Rivers Edge Dr
Hayward, WI 54843-7800
Phone (715) 634-2541

300 Main St W
Ashland, WI 54806-3696
Phone (715) 685-2200

7665 US Hwy 2
Iron River, WI 54847-4690
Phone (715) 372-5001

Hospital & facility affiliations

  • Transitions Home Health of Central Wisconsin Home health agency, Stevens Point, WI, CCN 527330
  • Regional Hospice Services Hospice, Ashland, WI, CCN 521539
  • Tamarack Health Hayward Medical Center Hospital, Hayward, WI, CCN 521336
  • Hayward Health Services Nursing home, Hayward, WI, CCN 525434

Merit-based Incentive Payment System (MIPS)

Final score
93.05 of 100Reported as group
Quality
87.37
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39957WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Lakes Community Health Center, Inc Current Accepting new patients
The Lakes Community Health Center, Inc CurrentSince Sep 1, 2013 Accepting new patients
The Lakes Community Health Center, Inc CurrentSince Sep 1, 2013 Accepting new patients
The Lakes Community Health Center, Inc Past Accepting new patients

Locations

300 Main St W
Ashland, WI 54806
Phone (715) 685-2200

15735 W US Highway 63
Hayward, WI 54843

15954 Rivers Edge Dr
Hayward, WI 54843

11128 N State Road 77
Hayward, WI 54843
Phone (715) 934-3124

7665 US Highway 2
Iron River, WI 54847
Phone (715) 372-5001

600 W Shell Creek Rd
Minong, WI 54859
Phone (715) 364-8565

Interoperability endpoints

  • Direct secure messaging: bkelley281693@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tamarack Health Hayward ClinicHayward, WI, CCN 528644 Rural health clinic Corporate Director Apr 1, 2003

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 4

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1750306288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15735 W US HIGHWAY 63",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436475",
            "telephone_number": "888-834-4551",
            "fax_number": "715-598-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15954 RIVERS EDGE DR",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548437800",
            "telephone_number": "715-634-2541",
            "fax_number": "715-634-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "BRENT",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30086600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

Verify at the official NPI Registry.