KEVIN J KELLY MD NPI 1982606315

NPI Information

NPI: 1982606315
Provider Name: KEVIN J KELLY, MD
Classification: Internal Medicine - 207RC0000X
Entity Type: Individual

Specialization: Cardiovascular Disease

PECOS Registration: Yes

Address:
11108 PARKVIEW CIRCLE DR
FORT WAYNE, IN
ZIP 46845
Phone: (260) 266-5700
Get Directions

Kevin J Kelly, MD is a cardiovascular disease internal medicine in Fort Wayne, IN. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. Kevin J Kelly, MD NPI is 1982606315. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

11108 PARKVIEW CIRCLE DR
FORT WAYNE, IN
ZIP 46845-730
Phone: (260) 266-5700
Fax: (260) 266-5920

The NPI 1982606315 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/15/2005 and was last updated on 11/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	01032406A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000641087	OTHER	INDIANA	ANTHEM
2	KE0643399	MEDICARE PIN	OHIO
3	0522401	MEDICAID	OHIO
4	KE0643398	MEDICARE PIN	OHIO
5	100360760	MEDICAID	INDIANA
6	060071114	MEDICARE PIN	INDIANA
7	193590J	MEDICARE PIN	INDIANA
8	4284861	MEDICARE PIN	OHIO
9	060070567	MEDICARE PIN	INDIANA
10	264380G	MEDICARE PIN	INDIANA
11	P00846125	OTHER	OHIO	MEDICARE RAILROAD
12	P00786817	OTHER	INDIANA	R.R. MEDICARE
13	060070567	OTHER	INDIANA	RR MEDICARE
14	060071114	OTHER	OHIO	RR MEDICARE
15	06199	OTHER	OHIO	MEDICAID OHIO PARAMONT
16	D95309	MEDICARE UPIN	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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