Individual provider Active NPI

Kelsey Rhae Williams Henry, MD

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1841817772
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME155672 Issued in FL
Practice address
655 W 8TH St FL Center4
Jacksonville, FL 32209-6511
Phone
(904) 383-1002
Fax
(904) 244-5965
NPI assigned
Jun 26, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TRN31496 FL
Student in an Organized Health Care Education/Training Program 390200000X ME155672 FL
Family Medicine Physician 207Q00000X ME155672 FL Primary

Addresses

Primary practice location

655 W 8TH St FL Center4
Jacksonville, FL 32209-6511

Mailing address

PO Box 44008
Jacksonville, FL 32231-4008
Phone (904) 383-1002

Other practice location 1

2627 Riverside Ave
Jacksonville, FL 32204-4717
Phone (904) 308-7372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230821001835 FL Practitioner - Family Practice 0547686479 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

1255 Lila St
Jacksonville, FL 32208-3550

2777 University Blvd W
Suite 26
Jacksonville, FL 32217-2143
Phone (904) 633-0475

653 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-7874

655 W 8TH St
Jacksonville, FL 32209-6511

Hospital & facility affiliations

  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME155672FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc Family Medicine Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 1, 2023 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. Family Medicine Past Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

655 W 8th St
#4
Jacksonville, FL 32209
Phone (904) 244-4502

1255 Lila St
Jacksonville, FL 32208
Phone (904) 244-5700

Interoperability endpoints

  • Direct secure messaging: kelsey.williams.1@8967.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1841817772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-383-1002",
            "fax_number": "904-244-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST FL CENTER4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-383-1002",
            "fax_number": "904-244-5965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2627 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044717",
            "country_code": "US",
            "telephone_number": "904-308-7372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "KELSEY",
        "middle_name": "RHAE WILLIAMS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-26",
        "last_updated": "2024-01-08",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN31496",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "ME155672",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME155672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.