Kevin J Kelly, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

01032406A Issued in IN

Practice address

11108 Parkview Circle Dr
Fort Wayne, IN 46845-1730

Phone

(260) 266-5700

Fax

(260) 266-5920

NPI assigned

Aug 15, 2005

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 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Fort Wayne Cardiology Corporation

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1609852292
  NPD (past)

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1982606315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3926 NEW VISION DR",
            "address_2": "SUITE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451712",
            "telephone_number": "260-373-9705",
            "fax_number": "260-373-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11108 PARKVIEW CIRCLE DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451730",
            "telephone_number": "260-266-5700",
            "fax_number": "260-266-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01032406A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "060071114",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OHIO PARAMONT",
            "identifier": "06199",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R.R. MEDICARE",
            "identifier": "P00786817",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00846125",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000641087",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100360760",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0522401",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "060070567",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany S. Kellogg, MSW, LCSW
• Brynnan Nicole Kellogg
• Kelly Burke, LLC
• Kathryn Kelly Rethlake
• Crystal Kelly, MS
• Margaret Kelly, O.T.
• Mark Kim Kelly, M.D
• Tammi L Kelpin, LMT, RN
• Charles Lamoine Kelsey, D. C.
• Vicki Kelsey, D. C.

• Cardiovascular Disease Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Cardiovascular Disease Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.