Active NPI
Jonathan M Kelley, M.D.
- Anesthesiology Physician
- Sierra Madre, CA
National Provider Identifier
1982722674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- G26177
- Practice address
- 661 Woodland Dr
Sierra Madre, CA 91024-1445 - Phone
- (626) 355-1984
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | G26177 | CA | Primary |
Addresses
Primary practice location
661 Woodland Dr
Sierra Madre, CA 91024-1445
Mailing address
661 Woodland Dr
Sierra Madre, CA 91024-1445
Phone (626) 355-1984
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G261770 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G26177 | CA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357516800000",
"number": "1982722674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "661 WOODLAND DR",
"city": "SIERRA MADRE",
"state": "CA",
"postal_code": "910241445",
"telephone_number": "626-355-1984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "661 WOODLAND DR",
"city": "SIERRA MADRE",
"state": "CA",
"postal_code": "910241445",
"telephone_number": "626-355-1984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "JONATHAN",
"middle_name": "M",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2013-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "G26177",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G261770",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sierra Madre, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.