Shane E Kelley, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

49860 Issued in TN

Practice address

4117 E Emory Rd
Knoxville, TN 37938-4229

Phone

(865) 922-2121

Fax

(865) 922-0006

NPI assigned

Jul 9, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Internal Medicine

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Champion Physical Therapy LLC HallsGroup PAC ID 1355416306, shared by 4 NPIs, 277 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Knoxville, TN, CCN 447312
• Physicians Regional Medical Center Hospital, Powell, TN, CCN 440120
• University Health System, Inc Hospital, Knoxville, TN, CCN 440015
• Methodist Medical Center of Oak Ridge Hospital, Oak Ridge, TN, CCN 440034
• Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shane.kelley.1@20785.direct.athenahealth.com
• Direct secure messaging: shane.kelley.1@16930.direct.athenahealth.com

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.

• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  Medicare reassignment Care Compare group NPD
• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Knoxville, TN
  • NPI 1548349186
  NPD
• Summit Medical Group PLLC

  • Family Medicine Physician
  • Oak Ridge, TN
  • NPI 1437238797
  NPD (past)
• Summit Medical Group, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1699722470

  Internal Medicine

  NPD (past)
• Summit Medical Group,PLLC

  • Internal Medicine Physician
  • Cookeville, TN
  • NPI 1588362164
  NPD (past)

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

• Comprehensive Home Healthcare Services LLC

  • Home Health Agency
  • Knoxville, TN
  • NPI 1710935408
  Care Compare affiliation
• Fort Sanders Regional Medical Center

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1942294814
  Care Compare affiliation
• Methodist Medical Center

  • General Acute Care Hospital
  • Oak Ridge, TN
  • NPI 1700870672
  Care Compare affiliation
• Metro Knoxville Hma LLC

  • General Acute Care Hospital
  • Powell, TN
  • NPI 1043292899
  Care Compare affiliation
• University Health System, Inc.

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1538164090
  Care Compare affiliation

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1891007605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD UNIT 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091383",
            "telephone_number": "865-584-4747",
            "fax_number": "865-584-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 E EMORY RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379384229",
            "telephone_number": "865-922-2121",
            "fax_number": "865-922-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "SHANE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-09",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "49860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000692",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Kelley, NP
• Christopher Karol Kelley, D.C.
• Laura Wells Kelley, FNP
• Sandra Kaye Kelley, FNP-BC
• Scott David Kelley, PHARMD
• Sherri Necole Kelley
• Velvet Sunshine Kelley
• Williem Ronald Kelley, DC
• Brian Kelly, CRNA
• Britany Cobb Kelly, M.A. CCC-SLP

• Internal Medicine Physician in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.