Charles E Kelly II, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

40151 Issued in TN

Practice address

2839 Hwy 231 North
Suite 208a
Shelbyville, TN 37160-7449

Phone

(931) 685-8783

Fax

(931) 685-8784

NPI assigned

Sep 2, 2005

Last updated

Mar 13, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cekellyiimd@kellyclinic.ssdirect.aprima.com

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.

• Charles E Kelly II MD

  • Gastroenterology Physician
  • Shelbyville, TN
  • NPI 1457508160
  NPD (past) Authorized official

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1780678979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2839 HWY 231 NORTH",
            "address_2": "SUITE 208A",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371607449",
            "telephone_number": "931-685-8783",
            "fax_number": "931-685-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2839 HWY 231 NORTH",
            "address_2": "SUITE 208A",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371607449",
            "telephone_number": "931-685-8783",
            "fax_number": "931-685-8784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "40151",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "40151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3334724",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Howard Rupard MD
• Julie Barnes Complete Family Healthcare
• Barbara F Kaczmarska, M.D.
• Patti J. Kamykowski, N.P.
• Laura Rose Keith, OD
• Cory Lyn Kenyon, D.C.
• Kids Are Special LLC
• Kerry Kiesiner, D.C.
• Tressanique Kihugu, LPC-MHSP
• Marvin Clay Koonce, DDS

• Gastroenterology Physician in Shelbyville, TN
• Providers in Shelbyville, TN by specialty
• Gastroenterology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.