NPIMap

Organization Active NPI

William M. Kelly M.D., Inc.

  • Diagnostic Neuroimaging (Radiology) Physician
  • Palm Desert, CA
National Provider Identifier
1922082767
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Radiology) PhysicianTaxonomy code 2085D0003X
License
A34125 Issued in CA
Legal business name
WILLIAM M. KELLY M.D., INC.
Practice address
72980 Fred Waring Dr.
Ste. a
Palm Desert, CA 92260-9339
Phone
(760) 776-8001
Fax
(760) 674-8282
NPI assigned
Dec 5, 2005
Organization subpart
Yes
Parent organization
WILLIAM M. KELLY M.D., INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Radiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085D0003X A34125 CA Primary
Neuroradiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0700X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

72980 Fred Waring Dr.
Ste. a
Palm Desert, CA 92260-9339

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00341250MedicaidCA

Other names 1

  • Truly Open MRI 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.

Locations

72980 Fred Waring Dr
Ste A
Palm Desert, CA 92260
Phone (760) 776-8001

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": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1922082767",
    "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": "72980 FRED WARING DR.",
            "address_2": "STE. A",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922609339",
            "telephone_number": "760-776-8001",
            "fax_number": "760-674-8282"
        }
    ],
    "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": "2005-12-05",
        "last_updated": "2010-01-12",
        "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": "2085D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "CA",
            "license": "A34125",
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00341250",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Truly Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.