NPIMap

Organization Active NPI

Jody L. Kelly M.D. & Associates, LLC

Doing business as Jody L. Kelly M.D. & Associates, LLC - North

  • Specialist
  • Peoria, IL
National Provider Identifier
1881610475
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
JODY L. KELLY M.D. & ASSOCIATES, LLC
Doing business as
Jody L. Kelly M.D. & Associates, LLC - North
Practice address
5401 N. Knoxville Ave.
Suite 300
Peoria, IL 61614-5021
Phone
(309) 692-4702
Fax
(309) 692-0746
NPI assigned
Jul 15, 2006
Last updated
Dec 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Suzette M. Long, CPC, CPC-H
Title
Billing Coordinator
Phone
(309) 688-7082

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

5401 N. Knoxville Ave.
Suite 300
Peoria, IL 61614-5021

Mailing address

2901 N. Knoxville Ave.
Peoria, IL 61603-1747
Phone (309) 688-7010

Other names 1

  • Jody L. Kelly M.D. & Associates, LLC - North Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723001180 IL Part B Supplier - Clinic/Group Practice 9234119728 Receives reassigned benefits from 7 practitioners
Practice locations: Peoria, IL

National Provider Directory

National Provider Directory

Locations

2901 N Knoxville Ave
Peoria, IL 61603
Phone (309) 688-7010

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1881610475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N. KNOXVILLE AVE.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616031747",
            "telephone_number": "309-688-7010",
            "fax_number": "309-688-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N. KNOXVILLE AVE.",
            "address_2": "SUITE 300",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145021",
            "telephone_number": "309-692-4702",
            "fax_number": "309-692-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JODY L. KELLY M.D. & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "309-688-7082",
        "authorized_official_credential": "CPC, CPC-H"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jody L. Kelly M.D. & Associates, LLC - North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.