KEVIN M. JR. KELLY – Emergency Medicine Physician, NPI 1811924764

KEVIN M. JR. KELLY is a healthcare provider. based in La mesa, California. specializing in EMERGENCY MEDICINE. They hold a License No. A71711 (CA). The NPI Number for KEVIN M. JR. KELLY is 1811924764

Main info

Male
28 Years Of Experience
Accepts Medicare Assignment
Name
KEVIN M. JR. KELLY
NPI
1811924764
Phone
(619) 644-4401
Address
5555 GROSSMONT CENTER DRIVE
Enumeration Date
27 June 2006
Last Update Date
26 August 2008

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
Secondary Phone
8589393400
Graduation Year
1998 (28 years ago)
PAC ID
6002719887
Group Practice PAC ID
1052771698
Professional Enrollment ID
I20040129000399
Address ID
CA921232701SA7901XSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

5,791 EMERGENCY MEDICINE in CA

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Provider Addresses for KEVIN M. JR. KELLY

  • Sharp Grossmont Hospital, 5555, Grossmont Center Drive, La Mesa, San Diego County, California, 91942, United States

    LA MESA, CA 919423019

    Phone: (619) 644-4401

    Type: Location

  • PO BOX 12170

    WESTMINSTER, CA 926852170

    Phone: (877) 818-6102

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $141.

Total Amount is formed as General ($141) + Research ($0) + Ownership ($0) = $141.

Last reported payment date: 2024-06-11 • Largest payer in this snapshot: Inari Medical, Inc. ($141).

Total Amount

$141

General + Research + Ownership

Payments

1

Total payment records

General Amount

$141

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-11

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Inari Medical, Inc.$141
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-01-29

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040129000399IEmergency MedicineCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making298291$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only266250$0
99291Critical care, first 30-74 minutes5453$0
99284Emergency department visit with moderate level of medical decision making5252$0
View full utilization report →

Insurance plans in this area (ZIP 91942)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052771698View full group profile
NameSpecialtyState
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineMS
Emergency MedicineCA
Emergency MedicineCA
Emergency MedicineCA

Reviews

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Frequently asked questions

How is KEVIN M. JR. KELLY identified in CMS data?
CMS-hosted NPPES data lists KEVIN M. JR. KELLY with NPI 1811924764.
Does the file indicate KEVIN M. JR. KELLY is practicing under active NPI?
Directory data currently reports KEVIN M. JR. KELLY as active.
What is KEVIN M. JR. KELLY's primary classification?
Emergency Medicine Physician is the headline specialty for KEVIN M. JR. KELLY here. Clinical services aligned with this taxonomy classification.
Does KEVIN M. JR. KELLY list a practice location?
Patients near La Mesa, California may find KEVIN M. JR. KELLY in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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