Active NPI
William Ferris Kelly Jr., M.D.
- Specialist
- Jacksonville, NC
National Provider Identifier
1881727212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0034643
- Practice address
- 317 Western Blvd
Jacksonville, NC 28546-6338 - Phone
- (910) 577-2345
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0034643 | NC | Primary |
Addresses
Primary practice location
317 Western Blvd
Jacksonville, NC 28546-6338
Mailing address
107 Webb St
Swansboro, NC 28584-9668
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0760C | Other | NC | BLUE CROSS GROUP |
| 6907604 | Medicaid | NC | |
| 562014989001 | Other | NC | TRICARE GROUP |
| 8948216 | Medicaid | NC | |
| 48216 | Other | NC | BLUE SHIELD NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0034643 | NC | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Onslow Memorial Hospital, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Jacksonville, NC
- NPI 1689855900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1881727212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 WEBB ST",
"city": "SWANSBORO",
"state": "NC",
"postal_code": "285849668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 WESTERN BLVD",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466338",
"telephone_number": "910-577-2345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "WILLIAM",
"middle_name": "FERRIS",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "0034643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS GROUP",
"identifier": "0760C",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6907604",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE GROUP",
"identifier": "562014989001",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8948216",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NC",
"identifier": "48216",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.