NPIMap

Individual provider Active NPI

Kelly Victoria Rennie, M.D.

  • Trauma Surgery Physician
  • Charleston, WV
National Provider Identifier
1912187097
Registry record updated Sep 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
26075 Issued in WV
Practice address
1201 Washington St E
Suite 208
Charleston, WV 25301-1834
Phone
(304) 388-7270
NPI assigned
Nov 6, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X PGY.1.TUL-SURG LA
Trauma Surgery Physician 2086S0127X 26075 WV Primary

Addresses

Primary practice location

1201 Washington St E
Suite 208
Charleston, WV 25301-1834

Mailing address

1201 Washington St E
Suite 208
Charleston, WV 25301-1834
Phone (304) 388-7270

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140917002586 WV Practitioner - General Surgery 1254550676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tulane University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1220 Lee St E
Charleston, WV 25301-1863
Phone (304) 388-7270

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PGY.1.TUL-SURGLAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc Past Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Organizations & group practices 3

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 11

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": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411689600000",
    "number": "1912187097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 WASHINGTON ST E",
            "address_2": "SUITE 208",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011834",
            "telephone_number": "304-388-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 WASHINGTON ST E",
            "address_2": "SUITE 208",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011834",
            "telephone_number": "304-388-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNIE",
        "first_name": "KELLY",
        "middle_name": "VICTORIA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-06",
        "last_updated": "2014-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "PGY.1.TUL-SURG",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "WV",
            "license": "26075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.