Active NPI
Owen L Kelly, MD
- Orthopaedic Surgery Physician
- Russellville, AR
National Provider Identifier
1962461707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- E3477
- Practice address
- 401 N Phoenix Ave
Russellville, AR 72801-2844 - Phone
- (479) 890-5355
- Fax
- (479) 890-5366
- NPI assigned
- Mar 21, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | E3477 | AR | Primary |
Addresses
Primary practice location
401 N Phoenix Ave
Russellville, AR 72801-2844
Mailing address
PO Box 690
Russellville, AR 72811-1146
Phone (479) 890-5355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182582002 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080618000168 | AR | Practitioner - Orthopedic Surgery | 5092801472 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E3477 | AR | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mary'S Physician Services LLC | Current | Accepting new patients | |
| St Marys Physician Services, LLC | Current | Accepting new patients | |
| St Marys Physician Services, LLC | Past | Accepting new patients |
Locations
401 N Phoenix Ave
Russellville, AR 72801
Phone (479) 890-5355
101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345
Interoperability endpoints
- owen.kelly.1@2433.direct.athenahealth.com
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.
-
- Durable Medical Equipment & Medical Supplies
- Russellville, AR
- NPI 1063626117
-
- Interventional Cardiology Physician
- Russellville, AR
- NPI 1720356207
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Primary Care Clinic/Center
- Plainview, AR
- NPI 1871852434
Hospital
-
- Primary Care Clinic/Center
- Danville, AR
- NPI 1073748406
Hospital
-
- Primary Care Clinic/Center
- Havana, AR
- NPI 1346431384
Hospital
-
- Rural Acute Care Hospital
- Danville, AR
- NPI 1902842255
Hospital
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- University of Arkansas College of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Marys Physician Services LLC
Practice addresses (Care Compare)
401 N Phoenix Ave
Russellville, AR 72801-2844
Phone (479) 890-5355
Hospital & facility affiliations
- St Marys Regional Medical Center
- Johnson Regional Medical Center
- Chambers Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Knee replacement | 12 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Removal of tissue | 1-10 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692662400000",
"number": "1962461707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 690",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728111146",
"telephone_number": "479-890-5355",
"fax_number": "479-890-5366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 N PHOENIX AVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012844",
"telephone_number": "479-890-5355",
"fax_number": "479-890-5366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "OWEN",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2023-08-22",
"certification_date": "2023-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "AR",
"license": "E3477",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182582002",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.