Physician Compare National (NPI:1164416228)

HEALTHCARE PROVIDER: CARMEL M KELLY MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164416228
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789631284
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050406001046
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KELLY
	Individual professional last name
Provider First Name	CARMEL
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	COMMUNITY PHYSICIANS ASSOCIATES INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7315931482
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1093 N MAIN ST
	Group Practice or individual's line 1 address
City	RANDOLPH
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	023682100
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7819630676
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220108
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BETH ISRAEL DEACONESS HOSPITAL - MILTON
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220100
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTH SHORE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	220060
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y