NPIMap

Individual provider Active NPI

William R Kelley Jr., MD

  • Diagnostic Radiology Physician
  • Trinity, FL
National Provider Identifier
1780666560
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
159835 Issued in FL
Practice address
9330 State Road 54
Trinity, FL 34655-1808
Phone
(904) 399-5800
NPI assigned
Nov 16, 2005
Last updated
May 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 27770 AZ
Diagnostic Radiology Physician 2085R0202X C51795 CA
Diagnostic Radiology Physician 2085R0202X 159835 FL Primary

Addresses

Primary practice location

9330 State Road 54
Trinity, FL 34655-1808

Mailing address

4825 Hwy 95
Fort Mohave, AZ 86426-8315
Phone (760) 326-7225

Other practice location 1

1101 Cumberland Xing Dept Of
Valparaiso, IN 46383-2356
Phone (928) 234-5883

Other identifiers 3

IdentifierTypeStateIssuer
00C517950MedicaidCA
914673MedicaidAZ
100505339MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, AZ, FL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040202000057 IN Practitioner - Diagnostic Radiology 7517860968 Reassigns benefits to 3 organizations
I20050323000216 AZ Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 7517860968 Reassigns benefits to 1 organization
I20230202001895 FL Practitioner - Diagnostic Radiology 7517860968 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imaging Associates of Indiana PCGroup PAC ID 1254503345, 293 clinicians
Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians

Practice addresses (Care Compare)

10706 Versailles Blvd
Wellington, FL 33449-8086
Phone (219) 767-6320

13695 US Hwy 1
Sebastian, FL 32958-3230
Phone (904) 399-5550

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 399-5550

2963 Black Goose Blvd
Fort Wayne, IN 46814-9487
Phone (904) 399-5550

726 Old Suman Rd
Valparaiso, IN 46383-9716
Phone (904) 399-5550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.77 of 100Reported as group
Quality
95.89
Improvement activities
40
Cost
81.38

Merit-based Incentive Payment System (MIPS)

Final score
78.06 of 100Reported as group
Quality
72.79
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
159835FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mori Bean and Brooks Inc Diagnostic Radiology CurrentSince Dec 16, 2022 Accepting new patients
Simonmed Reno PLLC Diagnostic Radiology CurrentSince Jun 1, 2024 Accepting new patients
Radiologic Associates of Northwest Indiana, PC Diagnostic Radiology Past Accepting new patients
Dunes Optical, LLC Past Accepting new patients
Medical Group Surgery Center LLC Past Accepting new patients

Locations

16220 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254

6900 E Camelback Rd
Ste 700
Scottsdale, AZ 85251
Phone (602) 651-1945

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

14302 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 975-1111

2115 Little Rd
Trinity, FL 34655
Phone 7278418225410

9330 State Road 54
Trinity, FL 34655
Phone (727) 834-4000

7455 W Washington Ave
Ste 120
Las Vegas, NV 89128
Phone (702) 433-6455

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 5

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": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1780666560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 HWY 95",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864268315",
            "telephone_number": "760-326-7225",
            "fax_number": "760-326-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 STATE ROAD 54",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551808",
            "telephone_number": "904-399-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Cumberland Xing Dept Of",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832356",
            "country_code": "US",
            "telephone_number": "928-234-5883",
            "fax_number": "928-492-1028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "WILLIAM",
        "middle_name": "R",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "27770",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C51795",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "159835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C517950",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "914673",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505339",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

Verify at the official NPI Registry.