NPIMap

Organization Active NPI

William M. Kelly M.D., Inc.

  • Specialist
  • Temecula, CA
National Provider Identifier
1891969960
Registry record updated Jan 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A34125 Issued in CA
Legal business name
WILLIAM M. KELLY M.D., INC.
Practice address
31565 Rancho Puebla Rd
Suite 101
Temecula, CA 92592-4839
Phone
(951) 302-2225
Fax
(951) 302-2210
NPI assigned
Apr 18, 2008
Organization subpart
Yes
Parent organization
WILLIAM M. KELLY M.D., INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2010

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

Authorized official

Name
Ms. Melonie Storer
Title
Credentialing Administrator
Phone
(951) 302-2223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A34125 CA Primary
Diagnostic Neuroimaging (Radiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085D0003X

Addresses

Primary practice location

31565 Rancho Puebla Rd
Suite 101
Temecula, CA 92592-4839

Mailing address

44489 Town Center Way
Ste. D
Palm Desert, CA 92260-2789
Phone (760) 776-9777

Other names 1

  • Health Scan Imaging Doing business as

National Provider Directory

National Provider Directory
Tax ID family
William M Kelly MD Inc10 organizations share this tax ID, including this one
Part of
William M Kelly MD Inc

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1891969960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44489 TOWN CENTER WAY",
            "address_2": "STE. D",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922602789",
            "telephone_number": "760-776-9777",
            "fax_number": "760-776-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31565 RANCHO PUEBLA RD",
            "address_2": "SUITE 101",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925924839",
            "telephone_number": "951-302-2225",
            "fax_number": "951-302-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM M. KELLY M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM M. KELLY M.D., INC.",
        "enumeration_date": "2008-04-18",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "STORER",
        "authorized_official_first_name": "MELONIE",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "951-302-2223",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A34125",
            "primary": true
        },
        {
            "code": "2085D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Scan Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Temecula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.