Active NPI
James Kelly
- Psychiatry Physician
- Easton, MD
National Provider Identifier
1922547520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- H0036293
- Practice address
- 29466 Pintail Dr
Suite 5
Easton, MD 21601-9323 - Phone
- (443) 515-0580
- NPI assigned
- Feb 15, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | H0036293 | MD | Primary |
Addresses
Primary practice location
29466 Pintail Dr
Suite 5
Easton, MD 21601-9323
Mailing address
PO Box 2878
Easton MD
Easton, MD 21601-8953
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0685356 00 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 10, 2017 through Jan 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0036293 | MD | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487116800000",
"number": "1922547520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2878",
"address_2": "EASTON MD",
"city": "EASTON",
"state": "MD",
"postal_code": "216018953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29466 PINTAIL DR",
"address_2": "SUITE 5",
"city": "EASTON",
"state": "MD",
"postal_code": "216019323",
"telephone_number": "443-515-0580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JAMES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-15",
"last_updated": "2017-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MD",
"license": "H0036293",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0685356 00",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Easton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.