SAMUEL K KELLEY (M.D.) – Child & Adolescent Psychiatry Physician, NPI 1154368199
Child & Adolescent Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
398 PSYCHIATRY in KY
Provider Addresses for SAMUEL K KELLEY (M.D.)
5050 VILLAGE SQUARE DR STE B
PADUCAH, KY 420017552
Phone: (270) 534-5128
Type: Mailing
2327 NEW HOLT RD
PADUCAH, KY 420017404
Phone: (270) 534-5128
Fax: (270) 477-0007
Type: Location
2520 New Holt Rd Ste I
Paducah, KY 420017547
Phone: (270) 558-3919
Type: Location
5050 Village Square Dr Ste B
Paducah, KY 420017552
Phone: (617) 877-8292
Type: Location
6, Mystic Avenue, Medford, Middlesex County, Massachusetts, 02155, United States
C/O JUDY DONNELLY - DCS MENTAL HEALT
MEDFORD, MA 021554632
Phone: (617) 877-8292
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2025-05-01
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250501000574 | I | Psychiatry | KY | TBD |
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.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 42001)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | KY | |
| Clinical Social Worker | KY | |
| Physician Assistant | KY | |
| Physician Assistant | KY | |
| Clinical Social Worker | KY | |
| Clinical Social Worker | KY | |
| Nurse Practitioner | KY | |
| Physician Assistant | TN | |
| Physician Assistant | KY | |
| Clinical Social Worker | KY |
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