Individual provider Active NPI

Carol E Kelly, P.A.

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1902133069
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50-001861 Issued in OH
Practice address
18101 Lorain Road
Cleveland, OH 44111
Phone
(216) 476-7000
NPI assigned
Nov 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50-001861 OH Primary

Addresses

Primary practice location

18101 Lorain Road
Cleveland, OH 44111

Mailing address

PO Box 74953
Cleveland, OH 44194-1036
Phone (440) 879-0081

Other practice location 1

1730 W 25th St Ste 4A
Cleveland, OH 44113-3108
Phone (216) 425-7674

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091203000085 OH Practitioner - Physician Assistant 8820137920 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

1730 W 25TH St
Cleveland, OH 44113-3108

24700 Lorain Rd
North Olmsted, OH 44070-2068

5001 Rockside Rd
Independence, OH 44131-2172
Phone (216) 986-4000

5334 Meador Lane CT
Sheffield Village, OH 44035-1469

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50-001861OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Dec 2, 2014 Accepting new patients

Locations

18101 Lorain Ave
Cleveland, OH 44111
Phone (216) 476-7029

10654 Lorain Ave
Cleveland, OH 44111
Phone (216) 941-1044

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

1730 W 25th St
Ste 4A
Cleveland, OH 44113
Phone (216) 363-2292

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1902133069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74953",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441941036",
            "telephone_number": "440-879-0081",
            "fax_number": "440-879-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 LORAIN ROAD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44111",
            "telephone_number": "216-476-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1730 W 25th St Ste 4A",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441133108",
            "country_code": "US",
            "telephone_number": "216-425-7674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CAROL",
        "middle_name": "E",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-11",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-001861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.