Jody L Kelly, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036102228 Issued in IL

Practice address

2901 N. Knoxville Ave.
Peoria, IL 61603

Phone

(309) 688-7010

Fax

(309) 688-7044

NPI assigned

Jul 12, 2005

Reactivated

Mar 27, 2006

Last updated

Dec 7, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jody L Kelly MD and Associates, LLCGroup PAC ID 9234119728, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jody L. Kelly M.D. & Associates, LLC

  dba Jody L. Kelly M.D. & Associates, LLC - North

  • Specialist
  • Peoria, IL
  • NPI 1881610475
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323216000000",
    "number": "1932107208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N. KNOXVILLE AVE.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-688-7010",
            "fax_number": "309-688-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N. KNOXVILLE AVE.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-688-7010",
            "fax_number": "309-688-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JODY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2011-12-07",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036102228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102228",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Eugene Kellenberger, APRN-C
• Kimberly Ann Kelley, R.D.
• Amanda Marie Kelly, PT
• Calista R Kelly, P.T.
• Janelle Leann Kelly, PT
• Joseph P Kelly IV, PT
• Julie Ann Kelly, MS-CCC/SLP
• Keri S Kelly, PT
• Molly Jo Kelly, PT
• Jennifer Michelle Kelsey, APN

• Obstetrics & Gynecology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.