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EDWARD LESLIE KELLY MD
NPI 1013995471
Psychiatry & Neurology - Forensic Psychiatry in Provo, UT

Active since January 05, 2006PECOS EnrolledAccepts Medicare Assignment
1300 E CENTER ST, PROVO, UT 84606(801) 344-4400(801) 344-4225 Get Directions Write a Review

NPPES record last updated: March 24, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 24, 2025, Jul 2, 2020, Aug 12, 2016 and 1 more (4 updates tracked since 2016).

About Edward Leslie Kelly Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDWARD LESLIE KELLY MD (NPI 1013995471) is an individual forensic psychiatry provider in Provo, Utah, licensed in Utah (10382404-1205) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1992).

NPPES Registry Identity

NPI1013995471
Entity TypeIndividualMale
Primary Taxonomy2084F0202X
Provider Legal NameEDWARD LESLIE KELLYCredential: MD
Location Address1300 E CENTER STProvo, UT 84606-3554
Mailing AddressPo Box 270Provo, UT 84603-0270 · (801) 344-4400 · Fax (801) 344-4225
Phone(801) 344-4400
Fax(801) 344-4225
Sole ProprietorNo
Medical School CMSOtherGraduated 1992
Enumeration DateJanuary 5, 2006
Last NPPES UpdateMarch 24, 20254 updates tracked since enumeration
NPPES CertifiedMarch 24, 2025
✔ NPI 1013995471 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPsychiatry & Neurology · Forensic PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084F0202X
Licenses✔ Licensed in UT · 10382404-1205✔ Licensed in NE · 26951✔ Licensed in MN · 42929✔ Licensed in WA · MD00040860
Definition
Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals.
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 26951 (NE), MD00040860 (WA)
Also ListedPsychiatry & Neurology · Child & Adolescent PsychiatryTaxonomy 2084P0804X · License MD00040860 (WA)
Also ListedPsychiatry & Neurology · Geriatric PsychiatryTaxonomy 2084P0805X · License MD00040860 (WA)
1300 E CENTER ST, Provo, UT 84606
Open in Google Maps ↗

Other Identifiers 1

Medicaid1013995471WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Edward Leslie Kelly Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325079577
PECOS Enrollment IDI20190508001230
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Edward Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

State Of Utah
Same address
Psychiatric Hospital
1300 E CENTER ST
Provo, UT 84606
  • Reassigned Medicare billing, Utah enrollment
  • 84 clinicians in this Medicare group
NPI 1811978620 (801) 344-4400
Winona Health Services
1,058 mi
General Acute Care Hospital
855 MANKATO AVE
Winona, MN 55987
  • Reassigned Medicare billing, Minnesota enrollment
  • 330 clinicians in this Medicare group
NPI 1295789352 (507) 454-3650

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON EUGENE DEGRISELLES CTRS
Recreation Therapist
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4226
BRENNA GARRETT LCSW
Social Worker (Clinical)
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4400
WILLIAM KORY CAMP LCSW
Social Worker (Clinical)
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4215
UTAH STATE HOSPITAL
Psychiatric Hospital
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4331
KATIE DUVALL
Student in an Organized Health Care Education/Training Program
1300 E CENTER ST
PROVO, UT 84606
Utah County (013) 444-4400
KAZIA RYAN M.A.
Counselor
1300 E CENTER ST
PROVO, UT 84606
Utah County (385) 208-6904
THOMAS PAYNE LCSW
Social Worker (Clinical)
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4400
BRETT MORTENSEN CMHC
Counselor (Mental Health)
1300 E CENTER ST
PROVO, UT 84606
Utah County (801) 344-4400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edward Kelly's NPI number?

The NPI number for Edward Kelly is 1013995471. It was assigned to this individual provider in the NPPES registry on January 5, 2006.

Where is Edward Kelly located?

Edward Kelly practices at 1300 E Center St, Provo, UT 84606. The listed phone number is (801) 344-4400.

What is Edward Kelly's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Forensic Psychiatry, with taxonomy code 2084F0202X.

Is Edward Kelly enrolled in Medicare?

Yes. Edward Kelly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Edward Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Edward Kelly reassigns Medicare benefits to 2 organizations: State Of Utah (Provo, UT) and Winona Health Services (Winona, MN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Edward Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Edward Kelly accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Edward Kelly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Edward Kelly was last updated on March 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.