Robert B Kelly, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD 20525 Issued in OR

Practice address

665 Winter St SE
Salem, OR 97301-3919

Phone

(503) 561-5634

NPI assigned

Sep 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 6

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

Owned or controlled facilities with NPI records 3

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

• Salem Health

  • General Acute Care Hospital
  • Salem, OR
  • NPI 1265431829

  Corporate Director

  CMS ownership
• Salem Health

  • Family Medicine Physician
  • Woodburn, OR
  • NPI 1578112066

  Corporate Director

  CMS ownership
• Salem Health West Valley

  • Critical Access Hospital
  • Dallas, OR
  • NPI 1245237486

  Corporate Director

  CMS ownership

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.

• Salem Emergency Physicians Service, PC

  • Emergency Medicine Physician
  • Salem, OR
  • NPI 1063454395

  Emergency Medicine, OR

  Medicare reassignment NPD
• Salem Health

  • General Acute Care Hospital
  • Salem, OR
  • NPI 1265431829

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1750488359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2505",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973082505",
            "telephone_number": "888-828-3198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013919",
            "telephone_number": "503-561-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ROBERT",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-19",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD 20525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARION POLK CHP",
            "identifier": "150504",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "M400721",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A056",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150504",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE",
            "identifier": "G53960",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "G53960",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8209959",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Kellogg
• Cindy Kelly
• Debra Kelly, RTR.
• Elizabeth Kelly, RN
• Michael Paul Kelly, PHARM.D.
• Robert R Kelly, M.D.
• Samuel Robert Kelly
• Tanner J Kelly, MD
• Victoria Kelly
• Michele J Kelsey, THW CRM PSS

• All providers in Salem, OR
• Emergency Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.