Thomas Charles Kelly, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

4301084281 Issued in MI

Practice address

207 Landmark Dr
Suite a
Normal, IL 61761-3195

Phone

(309) 268-3200

NPI assigned

May 31, 2007

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

Medicare fee-for-service enrollment

Enrolled in IL

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

Otolaryngology

Education

Southern Illinois University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
• Saint James Hospital Hospital, Pontiac, IL, CCN 140161
• Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment NPD
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

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

• Ottawa Regional Hospital & Healthcare Center

  • General Acute Care Hospital
  • Peru, IL
  • NPI 1588713440
  Care Compare affiliation
• Saint James Hospital

  • General Acute Care Hospital
  • Pontiac, IL
  • NPI 1407808090
  Care Compare affiliation
• St Joseph Medical Center

  • General Acute Care Hospital
  • Bloomington, IL
  • NPI 1619916806
  Care Compare affiliation

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353369600000",
    "number": "1891997110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 LEE ST",
            "address_2": "SUITE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164539",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 LANDMARK DR",
            "address_2": "SUITE A",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613195",
            "telephone_number": "309-268-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THOMAS",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2012-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301084281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William O Kauth Sr., PH.D, ATC
• Benjamin Keating, M.D.
• Carrie Keller, BS
• Nicole Angela Kelley, LCSW
• Adam Richard Kelly, ATC
• Kristin Kendrick
• Susan M Keogh, LCPC
• Caitlin Keroack, ATC
• Sidney E Kessinger, RSA, CSFA
• Andrew Keto, D.O.

• Otolaryngology Physician in Normal, IL
• Providers in Normal, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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.