Jerry S Kelly, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00003961 Issued in NY

Practice address

3719 Union Rd
Cheektowaga, NY 14225-4249

Phone

(716) 681-7394

Fax

(716) 685-9087

NPI assigned

Jan 5, 2007

Sex

Male

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 NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suburban Psychiatric Associates, LLPGroup PAC ID 6709774318, 35 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Suburban Psychiatric Associates, LLP

  • Psychiatry Physician
  • Amherst, NY
  • NPI 1851331367
  Medicare reassignment Care Compare group NPD
• Catholic Charities of Buffalo

  • Community/Behavioral Health Agency
  • Buffalo, NY
  • NPI 1962596718
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962559278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 WASHINGTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031711",
            "telephone_number": "716-856-4494",
            "fax_number": "716-842-1277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 UNION RD",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142254249",
            "telephone_number": "716-681-7394",
            "fax_number": "716-685-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JERRY",
        "middle_name": "S",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "00003961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00030241501",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fulton Keagle, RPH
• Shannon Keating, LPN
• Sharon Kelchlin
• Erin E Kelley
• Kelly McMurray
• Kendall Performance Physical Therapy PLLC
• Christina Kennedy Kennedy, MA CCC/SLP
• Timothy Kennedy, MS, ATC
• Daniel Kenneweg
• Megan Elizabeth Keogh, PA-C

• Clinical Social Worker in Cheektowaga, NY
• Providers in Cheektowaga, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.