Kelly E Fordyce MD a Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

KELLY E FORDYCE MD A MEDICAL CORPORATION

Practice address

777 Corporate Dr Ste 140
Ladera Ranch, CA 92694-2136

Phone

(949) 409-4868

Fax

(949) 409-4898

NPI assigned

May 3, 2021

Last updated

Jun 1, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly E Fordyce, MDNPI 1477531481

Title

Owner

Phone

(949) 573-8335

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Elizabeth Fordyce, M.D.

  • Internal Medicine Physician
  • Mission Viejo, CA
  • NPI 1477531481
  Medicare reassignment Care Compare group NPD Authorized official
• Roxanne Stallworth, M.D., M.P.H.

  • Internal Medicine Physician
  • Costa Mesa, CA
  • NPI 1366678906
  Medicare reassignment Care Compare group NPD
• Nicole Marie Franklin, P.A.-C

  • Medical Physician Assistant
  • Mission Viejo, CA
  • NPI 1215023718
  Medicare reassignment

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1831772417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 CORPORATE DR STE 140",
            "city": "LADERA RANCH",
            "state": "CA",
            "postal_code": "926942136",
            "telephone_number": "949-409-4868",
            "fax_number": "949-409-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 CORPORATE DR STE 140",
            "city": "LADERA RANCH",
            "state": "CA",
            "postal_code": "926942136",
            "telephone_number": "949-409-4868",
            "fax_number": "949-409-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY E FORDYCE MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "FORDYCE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-573-8335",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A732940",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kellyefordyce@gmail.com",
            "affiliation": "N",
            "address_1": "777 Corporate Dr Ste 140",
            "city": "Ladera Ranch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926942136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.kellyfordycemd.com",
            "affiliation": "N",
            "address_1": "777 Corporate Dr Ste 140",
            "city": "Ladera Ranch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926942136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stacy Jones, O.D.
• Jaxson Joseph Kane
• Karl J Gebhard MD Inc
• Avrum Aaron Kaufman, DO
• Megan Keithly, MOT, OTR/L
• Aaron Kelsey, DDS
• Kevin Kinback (AdvancedTMS Center)
• Gina Jaber Khouri, D.D.S.
• Jane G. Khoury, M.D.
• Miranda Kilzi, PHARMD

• Internal Medicine Physician in Ladera Ranch, CA
• Providers in Ladera Ranch, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.