NPIMap

Individual provider Active NPI

John Kelly, M.D.

  • Family Medicine Physician
  • Forest, VA
National Provider Identifier
1972952125
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101266447 Issued in VA
Practice address
1088 London Links Dr
Forest, VA 24551-4662
Phone
(574) 647-7477
NPI assigned
Jun 8, 2016
Last updated
Jul 18, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101266447 VA Primary

Addresses

Primary practice location

1088 London Links Dr
Forest, VA 24551-4662

Mailing address

1088 London Links Dr
Forest, VA 24551-4662
Phone (434) 534-6868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190913001090 VA Practitioner - Family Practice 6406148139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1088 London Links Dr
Forest, VA 24551-4662
Phone (434) 534-6868

118 Oakwood Dr
Madison Heights, VA 24572-3001

131 Jones St
Appomattox, VA 24522-9830
Phone (434) 352-8235

14005 Wards Rd
Suite a
Lynchburg, VA 24501-7127
Phone (434) 239-0132

2215 Landover PL
Lynchburg, VA 24501-2115
Phone (434) 947-3944

2600 Compass Rd
Glenview, IL 60026-8001

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101266447VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Family Medicine CurrentSince Jul 7, 2019 Accepting new patients
Privia Medical Group, LLC CurrentSince Jul 7, 2019 Accepting new patients
Medical Associates of Central Virginia, Inc. Past Accepting new patients

Locations

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

1088 London Links Dr
Forest, VA 24551
Phone (434) 382-1139

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • Direct secure messaging: john.kelly.1@8042.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1972952125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 LONDON LINKS DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514662",
            "telephone_number": "434-534-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 LONDON LINKS DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514662",
            "telephone_number": "574-647-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-08",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101266447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

Verify at the official NPI Registry.