Active NPI
Matthew J Kelly, M.D.
- Family Medicine Physician
- Santa Fe, NM
National Provider Identifier
1891860904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 72-167
- Practice address
- 1114 Hickox St
Santa Fe, NM 87505-1088 - Phone
- (505) 982-9961
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 72-167 | NM | Primary |
Addresses
Primary practice location
1114 Hickox St
Santa Fe, NM 87505-1088
Mailing address
1114 Hickox St
Santa Fe, NM 87505-1088
Phone (505) 982-9961
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72-167 | NM | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186012800000",
"number": "1891860904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1114 HICKOX ST",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875051088",
"telephone_number": "505-982-9961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 HICKOX ST",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875051088",
"telephone_number": "505-982-9961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MATTHEW",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2007-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "72-167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.