DR. JACOB NATHANIEL KELLY MD
NPI 1023713856
Student in an Organized Health Care Education/Training Program in Binghamton, NY

Q: What is Jacob Kelly's NPI number?

The NPI number for Jacob Kelly is 1023713856. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Q: What is Jacob Kelly's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Kelly was last updated on April 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.

Active since April 03, 2023PECOS Enrolled

169 RIVERSIDE DR, BINGHAMTON, NY 13905(607) 798-5111 Get Directions Write a Review

NPPES record last updated: April 3, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Jacob Nathaniel Kelly Md NPPES

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

DR. JACOB NATHANIEL KELLY MD (NPI 1023713856) is an individual student in an organized health care education/training program in Binghamton, New York and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1023713856

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. JACOB NATHANIEL KELLYCredential: MD

Location Address169 RIVERSIDE DRBinghamton, NY 13905-4246

Mailing Address8 Woodland AveCortland, NY 13045-1824 · (607) 259-1148

Phone(607) 798-5111

Sole ProprietorNo

Enumeration DateApril 3, 2023

NPPES CertifiedApril 1, 2023

✔ NPI 1023713856 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

169 RIVERSIDE DR, Binghamton, NY 13905

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jacob Nathaniel Kelly Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

JOANN MARIE ERNST FNP

Nurse Practitioner (Family)