MICK KELLY (MD) – Orthopaedic Surgery Physician, NPI 1053793208
Orthopaedic Surgery Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
628 ORTHOPEDIC SURGERY in WI
Provider Addresses for MICK KELLY (MD)
N15W28300 GOLF RD
PEWAUKEE, WI 530724800
Phone: (262) 303-5055
Fax: (262) 303-5057
Type: Mailing
590 S WAKARA WAY
SALT LAKE CITY, UT 841081200
Phone: (801) 587-5400
Type: Mailing
590 S Wakara Way
Salt Lake City, UT 841081200
Phone: (801) 587-5400
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 51 Open Payments records for all available years, with a total value of $14,535.
Total Amount is formed as General ($14,535) + Research ($0) + Ownership ($0) = $14,535.
Last reported payment date: 2024-12-16 • Largest payer in this snapshot: Medical Device Business Services, Inc. ($8,918).
Total Amount
$14,535
General + Research + Ownership
Payments
51
Total payment records
General Amount
$14,535
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medical Device Business Services, Inc. | $8,918 |
| Smith+Nephew, Inc. | $2,452 |
| Medacta USA, Inc. | $1,267 |
| Pacira Pharmaceuticals Incorporated | $646 |
| MEDACTA USA, INC. | $626 |
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: 2021-08-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20200610003336 | I | Orthopedic Surgery | UT | TBD |
| I20210809000856 | I | Orthopedic Surgery | WI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | 3,350 | 30 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 1,076 | 87 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 233 | 111 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 229 | 174 | $0 |
| 73502 | X-ray of hip, 2-3 views | 139 | 90 | $0 |
Insurance plans in this area (ZIP 53072)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | IL | |
| Physician Assistant | WI | |
| Occupational Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IL | |
| Occupational Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | WI | |
| Orthopedic Surgery | WI | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | WI | |
| Orthopedic Surgery | WI |
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