Individual provider Active NPI

Timothy L Kelly, CRNA

  • Certified Registered Nurse Anesthetist
  • West Columbia, SC
National Provider Identifier
1770567836
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
219 Issued in SC
Practice address
2720 Sunset Blvd
West Columbia, SC 29169
Phone
(803) 935-8292
NPI assigned
Dec 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 219 SC Primary

Addresses

Primary practice location

2720 Sunset Blvd
West Columbia, SC 29169

Mailing address

PO Box 6069
West Columbia, SC 29171-6069
Phone (803) 791-2203

Other practice location 1

67 Creekside Park Ct
Greenville, SC 29615-4810
Phone (864) 522-3700

Other practice location 2

701 Grove Rd
Greenville, SC 29605
Phone (864) 455-7111

Other practice location 3

67 Creekside Park Ct
Greenville, SC 29615-4810
Phone (864) 522-3700

Other practice location 4

7 Independence Pt Ste 300
Greenville, SC 29615-4569
Phone (864) 522-3700

Other identifiers 1

IdentifierTypeStateIssuer
AN0930MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tkelly187409@direct.lexmed.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC, GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050415000182 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244277788 Reassigns benefits to 3 organizations
I20220829002451 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244277788 Reassigns benefits to 1 organization
I20230417000266 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244277788 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lexington Health IncGroup PAC ID 2567872070, 905 clinicians

Practice addresses (Care Compare)

2720 Sunset Blvd
West Columbia, SC 29169-4810
Phone (803) 791-2460

Hospital & facility affiliations

  • Lexington Medical Center Hospital, West Columbia, SC, CCN 420073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health-Upstate CurrentSince Oct 1, 2016 Accepting new patients
Lexington County Health Services District Inc Current Accepting new patients
Lexington Health Inc CurrentSince Mar 1, 2025 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Aug 1, 2022 Accepting new patients
Greenville Health System CurrentSince Mar 15, 2014 Accepting new patients
Lexington Health Inc Current Accepting new patients
Pathology Associates of Greenville PA Current Accepting new patients
Lexington Health Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2025 Accepting new patients
Greenville Health System CurrentSince Mar 15, 2014 Accepting new patients
Prisma Health-Upstate CurrentSince Oct 1, 2016 Accepting new patients
Prisma Health-Upstate Current Accepting new patients
Emory Specialty Associates, LLC CurrentSince Apr 7, 2023 Accepting new patients
Greenville Health System Current Accepting new patients

Locations

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

1821 Clifton Rd NE
Atlanta, GA 30329
Phone (404) 728-6812

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

7035 Saint Andrews Rd
Columbia, SC 29212
Phone (803) 749-0924

175 Patewood Dr
Greenville, SC 29615
Phone (864) 797-1000

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

830 S Buncombe Rd
Greer, SC 29650
Phone (864) 797-8000

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

729 SE Main St
Simpsonville, SC 29681
Phone (864) 271-8647

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

2720 Sunset Blvd
West Columbia, SC 29169
Phone (803) 791-2480

Interoperability endpoints

  • Direct secure messaging: tkelly187409@direct.lexmed.com

Organizations & group practices 13

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 13

Hospital & facility affiliations 1

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": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1770567836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069",
            "telephone_number": "803-791-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "29169",
            "telephone_number": "803-935-8292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "67 Creekside Park Ct",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154810",
            "country_code": "US",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "29605",
            "country_code": "US",
            "telephone_number": "864-455-7111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "67 Creekside Park Ct",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154810",
            "country_code": "US",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7 Independence Pt Ste 300",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154569",
            "country_code": "US",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN0930",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkelly187409@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "2720 Sunset Blvd",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.