Individual provider Active NPI

Kellan E Ashley, MD

  • Interventional Cardiology Physician
  • Jackson, MS
National Provider Identifier
1790714954
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
18726 Issued in MS
Practice address
2500 N State Street
Cardiology
Jackson, MS 39216-4500
Phone
(601) 984-5678
Fax
(601) 984-5638
NPI assigned
Jul 1, 2006
Last updated
Oct 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 57.011859 OH
Cardiovascular Disease Physician 207RC0000X 18726 MS
Cardiovascular Disease Physician 207RC0000X 33296 AL
Interventional Cardiology Physician 207RI0011X 33296 AL
Interventional Cardiology Physician 207RI0011X 18726 MS Primary

Addresses

Primary practice location

2500 N State Street
Cardiology
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5678

Other identifiers 3

IdentifierTypeStateIssuer
130850MedicaidAL
P01233203OtherMSRAILROAD MEDICARE
04034504MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20060905000427 MS Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 9032113097 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Mississippi School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting17
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18726MSMDCardiovascular Disease Physician
57.011859OHMDCardiovascular Disease Physician
33296ALMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne General Hospital Current Accepting new patients
Cardiology Associates of Mobile Inc Cardiovascular Disease CurrentSince Jul 24, 2022 Accepting new patients
Wayne General Hospital CurrentSince Jul 1, 2020 Accepting new patients
Wayne General Hospital CurrentSince Jul 1, 2020 Accepting new patients
Ms Methodist Hospital & Rehabilitation Center Cardiovascular Disease Past Accepting new patients
University Physicians, PLLC Past Accepting new patients
Mississippi Methodist Hospital & Rehabilitation Center, Inc. Past Accepting new patients

Locations

188 Hospital Dr
Ste 205
Fairhope, AL 36532
Phone (251) 990-3701

6701 Airport Blvd
Ste D330
Mobile, AL 36608
Phone (251) 607-9797

950 Matthew Dr
Waynesboro, MS 39367
Phone (601) 735-5151

Interoperability endpoints

  • FHIR API: https://fhir.cardassoc.com/R4/open-R4
  • Direct secure messaging: kashley9967@ummc.direct-ci.com

Organizations & group practices 8

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 2

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1790714954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5678",
            "fax_number": "601-984-5638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE STREET",
            "address_2": "CARDIOLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5678",
            "fax_number": "601-984-5638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASHLEY",
        "first_name": "KELLAN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "57.011859",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "18726",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AL",
            "license": "33296",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AL",
            "license": "33296",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MS",
            "license": "18726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130850",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01233203",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04034504",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.