NPIMap

Individual provider Active NPI

Kelly D Ross, MD

  • Family Medicine Physician
  • Saint Ansgar, IA
National Provider Identifier
1770675399
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23076 Issued in IA
Practice address
140 W 4TH St Ste 1
Saint Ansgar, IA 50472-1352
Phone
(641) 736-4401
Fax
(641) 736-4407
NPI assigned
Sep 29, 2006
Last updated
May 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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 23076 IA Primary

Addresses

Primary practice location

140 W 4TH St Ste 1
Saint Ansgar, IA 50472-1352

Mailing address

140 W 4TH St Ste 1
PO Box 249
Saint Ansgar, IA 50472-1352
Phone (641) 736-4401

Other identifiers 2

IdentifierTypeStateIssuer
07000OtherIAWELLMARK
0213892MedicaidIA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kelly.ross@trinityhealthia.medicity.net Direct
Direct Messaging Address Kelly.Ross@direct.2.mycarefile.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20100507000618 IA Practitioner - Family Practice 0244277275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mitchell County Memorial HospitalGroup PAC ID 5890603070, shared by 6 NPIs, 23 clinicians

Practice addresses (Care Compare)

140 W 4TH St
Saint Ansgar, IA 50472-1352
Phone (641) 736-4401

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23076IAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mitchell County Memorial Hospital Current Accepting new patients
Mitchell County Memorial Hospital CurrentSince Feb 1, 1992 Accepting new patients
Mitchell County Memorial Hospital CurrentSince Feb 1, 1992 Accepting new patients
Floyd County Memorial Hospital Commission Family Medicine Past Accepting new patients

Locations

616 N 8th St
Osage, IA 50461
Phone (641) 732-6000

620 N 8th St
Osage, IA 50461
Phone (641) 732-6100

140 W 4th St
Saint Ansgar, IA 50472
Phone (641) 713-4381

140 W 4th St
Ste 1
Saint Ansgar, IA 50472
Phone (641) 736-4401

411 S Broad St
Stacyville, IA 50476
Phone (641) 737-2406

Interoperability endpoints

  • Direct secure messaging: kelly.ross@direct.2.mycarefile.org

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Good Samaritan Society- St AnsgarSaint Ansgar, IA, CCN 165210 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2017
May 1, 2017
Stacyville Community Nursing HomeStacyville, IA, CCN 165438 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2023
Jan 1, 2023

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 4

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 9

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1770675399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W 4TH ST STE 1",
            "address_2": "PO BOX 249",
            "city": "SAINT ANSGAR",
            "state": "IA",
            "postal_code": "504721352",
            "telephone_number": "641-736-4401",
            "fax_number": "641-736-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 W 4TH ST STE 1",
            "city": "SAINT ANSGAR",
            "state": "IA",
            "postal_code": "504721352",
            "telephone_number": "641-736-4401",
            "fax_number": "641-736-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KELLY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "23076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "07000",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0213892",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.ross@trinityhealthia.medicity.net",
            "affiliation": "N",
            "endpointDescription": "MItchell County Regional Health Services",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "140 W 4th St Ste 1",
            "city": "Saint Ansgar",
            "state": "IA",
            "country_code": "US",
            "postal_code": "504721352",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kelly.Ross@direct.2.mycarefile.org",
            "affiliation": "N",
            "endpointDescription": "MercyOne North Iowa Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "140 W 4th St Ste 1",
            "city": "Saint Ansgar",
            "state": "IA",
            "country_code": "US",
            "postal_code": "504721352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Ansgar, IA

Sources for this page

Verify at the official NPI Registry.