Russell S Kelly, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11807 Issued in HI

Practice address

91-2139 Fort Weaver Rd
Suite 300
Ewa Beach, HI 96706-3607

Phone

(808) 678-0700

Fax

(808) 678-0776

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

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 HI

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

Internal Medicine

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medical Office ForceGroup PAC ID 9335481951, 58 clinicians

Russell S Kelly MD LLCGroup PAC ID 2365548781, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Queens Medical Center Hospital, Honolulu, HI, CCN 120001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russell.kelly@6556243066884.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Russell S Kelly MD LLC

  • Primary Care Clinic/Center
  • Ewa Beach, HI
  • NPI 1598810814
  Medicare reassignment Care Compare group NPD Authorized official
• Medical Office Force

  • Internal Medicine Physician
  • Athens, GA
  • NPI 1508378613

  HI

  Medicare reassignment Care Compare group NPD

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

• The Queens Medical Center

  • General Acute Care Hospital
  • Honolulu, HI
  • NPI 1184612764
  Care Compare affiliation

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202256000000",
    "number": "1790787729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-2139 FORT WEAVER RD",
            "address_2": "SUITE 300",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967063607",
            "telephone_number": "808-678-0700",
            "fax_number": "808-678-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-2139 FORT WEAVER RD",
            "address_2": "SUITE 300",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967063607",
            "telephone_number": "808-678-0700",
            "fax_number": "808-678-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "RUSSELL",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2008-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "11807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000241885",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "539207",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joey L Keahiolalo
• Pamela Keanini
• Darcyann Emmalani Kela
• Brian W Kelley, PSYD
• Jasmine Marie Kelly, MD
• Ken Nagahiro
• Crystal Kerson
• Violeta G. Khun
• Sue Kilp, APRN-RX
• Diane K Kim, LCSW

• Internal Medicine Physician in Ewa Beach, HI
• Providers in Ewa Beach, HI by specialty
• Internal Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.