Active NPI
John Kelly Jr., DO
- Specialist
- Southfield, MI
National Provider Identifier
1902824295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 5101006257
- Practice address
- 24500 Northwestern Hwy
Southfield, MI 48075-2414 - Phone
- (248) 353-1280
- Fax
- (248) 353-6193
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 5101006257 | MI | Primary |
Addresses
Primary practice location
24500 Northwestern Hwy
Southfield, MI 48075-2414
Mailing address
24500 Northwestern Hwy
Southfield, MI 48075-2414
Phone (248) 353-1280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205209 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101006257 | MI | MD | Specialist |
| 06257 | MI | MD | Music Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr L Reynolds Assoc PC | Specialist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Southfield, MI
- NPI 1669423265
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187568000000",
"number": "1902824295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24500 NORTHWESTERN HWY",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752414",
"telephone_number": "248-353-1280",
"fax_number": "248-353-6193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24500 NORTHWESTERN HWY",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752414",
"telephone_number": "248-353-1280",
"fax_number": "248-353-6193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOHN",
"name_suffix": "Jr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MI",
"license": "5101006257",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1205209",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.