Individual provider Active NPI

Matthew William Kelecy

  • Student in an Organized Health Care Education/Training Program
  • Las Vegas, NV
National Provider Identifier
1841797867
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1701 W Charleston Blvd Ste 490
Las Vegas, NV 89102-2309
Phone
(702) 671-2273
NPI assigned
Apr 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1701 W Charleston Blvd Ste 490
Las Vegas, NV 89102-2309

Mailing address

1701 W Charleston Blvd Ste 490
Las Vegas, NV 89102-2309
Phone (702) 671-2273

Other practice location 1

500 S Preston St Rm 305
Louisville, KY 40202-1702
Phone (502) 852-8696

Other practice location 2

500 S Preston St Rm 305
Louisville, KY 40202-1702
Phone (502) 852-8696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20200730000972 NV Order and Referring Only - General SurgeryPractitioner - General Surgery 4688099237

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1841797867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W CHARLESTON BLVD STE 490",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022309",
            "telephone_number": "702-671-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W CHARLESTON BLVD STE 490",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022309",
            "telephone_number": "702-671-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 S Preston St Rm 305",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021702",
            "country_code": "US",
            "telephone_number": "502-852-8696",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 S Preston St Rm 305",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021702",
            "country_code": "US",
            "telephone_number": "502-852-8696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELECY",
        "first_name": "MATTHEW",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-06",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.