DR. PETER H KELLY (MD) – Surgery Physician, NPI 1669447850

DR. PETER H KELLY (MD) is a healthcare provider. based in Saint paul, Minnesota. specializing in Surgery Physician. They hold the professional credentials MD. They hold a License No. 29590 (MN). The NPI Number for DR. PETER H KELLY (MD) is 1669447850

Main info

Male
42 Years Of Experience
Accepts Medicare Assignment
Name
DR. PETER H KELLY (MD)
NPI
1669447850
Phone
(952) 843-4333
Address
310 SMITH AVE N
Enumeration Date
21 February 2006
Last Update Date
23 November 2020

Doctor Profile

Medical School Name
UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Secondary Phone
-
Graduation Year
1984 (42 years ago)
PAC ID
0446163232
Group Practice PAC ID
3971407636
Professional Enrollment ID
I20050525001078
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience69
Completeness75
Years active:20State licenses:1Digital endpointsOther names

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Provider Addresses for DR. PETER H KELLY (MD)

  • Smith Avenue North, West Seventh - Fort Road, Saint Paul, Ramsey County, Minnesota, 55102, United States

    SAINT PAUL, MN 551022383

    Phone: (952) 843-4333

    Fax: (952) 843-4301

    Mailing address matches the actual address.

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: 2005-05-25

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
I20050525001078IGeneral SurgeryMNTBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55102)

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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: 3971407636View full group profile

Reviews

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Frequently asked questions

Does DR. PETER H KELLY (MD) have a public NPI I can cite?
Public records show DR. PETER H KELLY (MD) under NPI 1669447850.
Quick check: is DR. PETER H KELLY (MD) active?
Public NPPES data shows DR. PETER H KELLY (MD) with an active NPI status right now.
What does the directory say DR. PETER H KELLY (MD) does?
Insurance directories may phrase it differently, but here DR. PETER H KELLY (MD) maps to Surgery Physician. Clinical services aligned with this taxonomy classification.
Can patients visit DR. PETER H KELLY (MD) in Saint Paul, Minnesota?
For routing, start with Saint Paul, Minnesota for DR. PETER H KELLY (MD), then verify phone and hours locally.
Can I export DR. PETER H KELLY (MD)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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