Michael J Kellis, D.O.

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

License

34004183 Issued in OH

Practice address

150 Seventh Ave Ste 200
Chardon, OH 44024-2909

Phone

(440) 285-4999

Fax

(402) 855-8704

NPI assigned

Aug 9, 2005

Last updated

Nov 2, 2023By 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 4

Medicare fee-for-service enrollment

Enrolled in OH

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

Sports Medicine

Education

Ohio University, College of Osteopathic Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Menorah Park Center for Senior LivingGroup PAC ID 3577469444, 79 clinicians

Beacon Orthopaedics and Sports Medicine LTDGroup PAC ID 0345136412, 471 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lake Health Hospital, Concord, OH, CCN 360098
• Uh Regional Hospitals Hospital, Chardon, OH, CCN 360075
• Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137
• University Hospitals Ahuja Medical Center Hospital, Beachwood, OH, CCN 360359

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michael.kellis.p1@direct.beaconortho.nextgenshare.com
• Direct secure messaging: mkellis37147@ehrdirect.uhhospitals.org

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.

• Beacon Orthopaedics & Sports Medicine, LTD

  dba OrthoAlliance of Ohio

  • Specialist
  • Cincinnati, OH
  • NPI 1386670065
  Medicare reassignment Care Compare group NPD
• Geauga Sports Medicine

  • Sports Medicine (Emergency Medicine) Physician
  • Auburn, OH
  • NPI 1699834390
  NPD Authorized official
• Beacon Orthopaedics & Sports Medicine LTD

  dba Ortho Foot and Ankle DBA OrthoAlliance of Ohio

  • Orthopaedic Foot and Ankle Surgery Physician
  • Worthington, OH
  • NPI 1699472878
  NPD
• Geauga Sports Medicine, LLC

  • Sports Medicine (Preventive Medicine) Physician
  • Chardon, OH
  • NPI 1396746970
  NPD

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

• Lake Hospital System Inc

  dba Lake Health

  • General Acute Care Hospital
  • Willoughby, OH
  • NPI 1972689172
  Care Compare affiliation
• Uh Regional Hospitals

  • General Acute Care Hospital
  • Chardon, OH
  • NPI 1669562864
  Care Compare affiliation
• University Hospitals Ahuja Medical Center, Inc

  dba UH Ahuja Medical Center

  • General Acute Care Hospital
  • Beachwood, OH
  • NPI 1609189604
  Care Compare affiliation
• University Hospitals Cleveland Medical Center

  dba Uhcmc

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1043397292
  Care Compare affiliation
• University Hospitals Cleveland Medical Center

  dba University Hospitals Mentor Health Center

  • Multi-Specialty Clinic/Center
  • Mentor, OH
  • NPI 1487770335

  Hospital

  Care Compare affiliation
• University Hospitals Cleveland Medical Center

  dba University Hospitals Westlake Health Center

  • Multi-Specialty Clinic/Center
  • Westlake, OH
  • NPI 1669598082

  Hospital

  Care Compare affiliation
• University Hospitals of Cleveland

  dba UH Case Medical Center

  • Clinic/Center
  • Cleveland, OH
  • NPI 1760673412

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1831190313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 HARRISON AVE STE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477961",
            "telephone_number": "440-285-4999",
            "fax_number": "440-285-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SEVENTH AVE STE 200",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440242909",
            "telephone_number": "440-285-4999",
            "fax_number": "402-855-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLIS",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "OH",
            "license": "34004183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "250006704",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4073792",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0658051",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "139662",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiara D Keegan
• Laura Keeley, PTA
• Jamie Keller
• Augustine J. Kellis, M.D.
• George J Kellis, M.D.
• James Wayne Kendzierski, COTA/L
• Trocon Keneah
• Winifred Keneah
• Rachel Kenenske
• Lisa Marie Kennedy, COTA/L

• Sports Medicine (Internal Medicine) Physician in Chardon, OH
• Providers in Chardon, OH by specialty
• Sports Medicine (Internal Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.