Active NPI
Anne M Kelly, MD
- Pediatric Adolescent Medicine Physician
- Minneapolis, MN
National Provider Identifier
1922197854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 33787
- Practice address
- 516 Delaware Street
PWB Fourth Floor, Room 4-100
Minneapolis, MN 55455 - Phone
- (612) 672-7122
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 33787 | MN | Primary |
Addresses
Primary practice location
516 Delaware Street
PWB Fourth Floor, Room 4-100
Minneapolis, MN 55455
Mailing address
420 Delaware St SE MMC 391
University of Minnesota Physicians
Minneapolis, MN 55455
Phone (612) 672-7122
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1274813 | Other | MN | MEDICA-PRIMARY |
| 768191 | Other | ARAZ | |
| 1000079 | Other | MN | PREFERRED ONE |
| HP21986 | Other | MN | HEALTH PARTNERS |
| 1224912 | Other | MN | MEDICA-CHOICE |
| 053876 | Other | MN | FAIRVIEW |
| 0908632 | Medicaid | IA | |
| 100911 | Other | MN | UCARE |
| 7T749KE | Other | MN | BCBS |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1922197854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE MMC 391",
"address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-672-7122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 DELAWARE STREET",
"address_2": "PWB FOURTH FLOOR, ROOM 4-100",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-672-7122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ANNE",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "MN",
"license": "33787",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA-PRIMARY",
"identifier": "1274813",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "768191",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1000079",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP21986",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA-CHOICE",
"identifier": "1224912",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAIRVIEW",
"identifier": "053876",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0908632",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "100911",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "7T749KE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.