NPIMap

Individual provider Active NPI

Nicholas Kelley, D.O

  • Emergency Medicine Physician
  • Wilkes Barre, PA
National Provider Identifier
1760830269
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS019482 Issued in PA
Practice address
575 N River St
Wilkes-Barre, PA 19702-2634
Phone
(570) 829-8111
NPI assigned
May 25, 2016
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OT017061 PA
Emergency Medicine Physician 207P00000X OS019482 PA Primary

Addresses

Primary practice location

575 N River St
Wilkes-Barre, PA 19702-2634

Mailing address

575 N River St
Wilkes Barre, PA 18702-2634
Phone (570) 829-8111

Other practice location 1

252 S 4th St
Lebanon, PA 17042-6111
Phone (717) 270-7688

Other practice location 2

169 Martin Ave
Ephrata, PA 17522-1734
Phone (717) 738-6420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20210419002253 PA Practitioner - Emergency MedicinePractitioner - Family Practice 1658703491 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ephrata Community HospitalGroup PAC ID 4981514445, 35 clinicians

Practice addresses (Care Compare)

169 Martin Ave
Ephrata, PA 17522-1734
Phone (717) 733-0311

252 S 4TH St
Lebanon, PA 17042-6111
Phone (717) 270-7500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT017061PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Pennsylvania Physician Services, LLC Emergency Medicine CurrentSince Apr 1, 2021 Accepting new patients
Lancaster General Hospital CurrentSince Nov 9, 2022 Accepting new patients
Ephrata Community Hospital CurrentSince May 26, 2025 Accepting new patients
Ephrata Community Hospital Emergency Medicine Current Accepting new patients
Lancaster General Hospital CurrentSince Nov 9, 2022 Accepting new patients
Pennsylvania Physician Services, LLC Emergency Medicine Current Accepting new patients
Ephrata Community Hospital Emergency Medicine CurrentSince May 26, 2025 Accepting new patients
Lancaster General Hospital Current Accepting new patients
The Good Samaritan Hospital of Lebanon, Pennsylvania Emergency Medicine CurrentSince Mar 11, 2024 Accepting new patients

Locations

169 Martin Ave
Ephrata, PA 17522
Phone (717) 733-0311

169 Martin Ave
#1002
Ephrata, PA 17522
Phone (717) 738-6818

555 N Duke St
Lancaster, PA 17602
Phone (717) 544-5945

252 S 4th St
Lebanon, PA 17042
Phone (717) 270-7500

317 Chestnut St
Quarryville, PA 17566
Phone (717) 544-3555

575 N River St
Wilkes Barre, PA 18764
Phone (570) 552-1300

575 N River St
Wilkes Barre Township, PA 18702
Phone (570) 283-3222

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

Interoperability endpoints

  • Direct secure messaging: nkelley418334@wellspan.direct-ci.com

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 7

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": "1464134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1760830269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187022634",
            "telephone_number": "570-829-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "197022634",
            "telephone_number": "570-829-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "252 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426111",
            "country_code": "US",
            "telephone_number": "717-270-7688",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "169 Martin Ave",
            "address_purpose": "LOCATION",
            "city": "Ephrata",
            "state": "PA",
            "postal_code": "175221734",
            "country_code": "US",
            "telephone_number": "717-738-6420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-25",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT017061",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS019482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.