Michael J Kelly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01029257 Issued in IN

Practice address

406 N 1St St
Vincennes, IN 47591-1340

Phone

(812) 885-2750

Fax

(812) 885-2756

NPI assigned

Dec 8, 2005

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 4

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkelly56427@direct.deaconess.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.

• Good Samaritan Hospital Physician Services, Inc

  • Hospitalist Physician
  • Vincennes, IN
  • NPI 1649432071

  Family Medicine

  Medicare reassignment NPD
• Family Medicine of Vincennes PC

  • Family Medicine Physician
  • Vincennes, IN
  • NPI 1881879237
  NPD (past) Authorized official
• Good Samaritan Hospital

  • Rural Health Clinic/Center
  • Vincennes, IN
  • NPI 1760145973
  NPD
• Good Samaritan Hospital

  • Rural Health Clinic/Center
  • Vincennes, IN
  • NPI 1063005601
  NPD (past)

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1811972128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 N 1ST ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911340",
            "telephone_number": "812-885-2750",
            "fax_number": "812-885-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 N 1ST ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911340",
            "telephone_number": "812-885-2750",
            "fax_number": "812-885-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01029257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000668746",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100427270",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00851313",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "M400018771",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucas Wade Jones, PA
• Samuel V Josephson, MD
• Alan Kaffenberger, PHARMD
• Silpa Kamisetti, M.D.
• Bradley Allen Keller, O.D.
• Mary Ann Kelso, RN
• Elizabeth Kelsoe, C.O.T.A.
• Arianna Kemper
• Racheal Kerns
• Michael Kerolus, MD

• Family Medicine Physician in Vincennes, IN
• Providers in Vincennes, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.