Jeffrey John Kelly, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5101020217 Issued in MI

Practice address

3643 W Front St
Suite a
Traverse City, MI 49684-7759

Phone

(231) 935-0620

Fax

(231) 935-0626

NPI assigned

Nov 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Dermatology

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associates in Dermatology of Traverse City PCGroup PAC ID 4981607298, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Merit-based Incentive Payment System (MIPS)

Final score

76.79 of 100Reported as individual

Quality

58.35

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://traversedermatology.mmi.prod.fhir.ema-api.com/fhir/r4/

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.

• Associates in Dermatology of Traverse City PC

  • Dermatopathology Physician
  • Traverse City, MI
  • NPI 1861430779
  Medicare reassignment Care Compare group NPD

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

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1770565384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3643 W FRONT ST",
            "address_2": "SUITE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847759",
            "telephone_number": "231-935-0620",
            "fax_number": "231-935-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 W FRONT ST",
            "address_2": "SUITE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847759",
            "telephone_number": "231-935-0620",
            "fax_number": "231-935-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "055534",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101020217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Kelley, M.A, LPC
• Jordan Paige Kelley
• Kelli Rae Kelley
• Carolynn A Kellogg, N.P.
• Kelly K Greene PC
• Joseph B Kelly, LPC
• Katherine Grace Kelly
• Kevin Charles Kelly, D.D.S.
• Kimberly Kelly, PSYD
• Marcy Kelly

• Dermatology Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.