Kelly R Anderson, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

02001311A Issued in IN

Practice address

520 S 7TH St
Vincennes, IN 47591-1038

Phone

(812) 885-3810

Fax

(812) 885-3811

NPI assigned

Sep 23, 2005

Last updated

Apr 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Emergency Medicine

Education

University of Kansas School of Med (KC/Wich/Sal), 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Emergency Medicine IncGroup PAC ID 1052666575, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Hospital Hospital, Vincennes, IN, CCN 150042

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Midwest Emergency Medicine, Inc.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Vincennes, IN
  • NPI 1801383278
  Medicare reassignment Care Compare group NPD

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

• Good Samaritan Hospital

  dba Center for Therapy and Sports Performance

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Vincennes, IN
  • NPI 1073153474

  Hospital

  Care Compare affiliation
• Good Samaritan Hospital

  • General Acute Care Hospital
  • Vincennes, IN
  • NPI 1225032881
  Care Compare affiliation

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1780670828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S 7TH ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911038",
            "telephone_number": "812-885-3685",
            "fax_number": "812-885-3917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S 7TH ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911038",
            "telephone_number": "812-885-3810",
            "fax_number": "812-885-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KELLY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02001311A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000110680",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200022500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amedco Indiana LLC (Wabash Valley Eye Center)
• Amedco Indiana LLC (Wabash Valley Eye Center)
• Amedco Indiana LLC (Wabash Valley Eye Center)
• Amedco Indiana LLC (Wabash Valley Eye Surgery Center)
• John Joseph Anderson, DMD
• Linda Anderson, LCSW
• Anesthesia Associates, Inc.
• Another Chance Christ Ministries
• Trista Armes, FNP-C
• Shalin Arnett, D.O.

• General Practice Physician in Vincennes, IN
• Providers in Vincennes, IN by specialty
• General Practice Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; 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.