DR. BRIAN D KELLY MD
NPI 1053637736
Pediatrics - Sports Medicine in Phoenix, AZ

Q: What is Brian Kelly's NPI number?

The NPI number for Brian Kelly is 1053637736. It was assigned to this individual provider in the NPPES registry on April 20, 2010.

Q: What is Brian Kelly's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Sports Medicine, with taxonomy code 2080S0010X.

Q: When was this NPI record last updated?

The NPPES record for Brian Kelly was last updated on January 11, 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 20, 2010PECOS Enrolled

1919 E THOMAS RD, PHOENIX, AZ 85016(602) 933-3033(602) 933-5245 Get Directions Write a Review

NPPES record last updated: January 11, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Brian D Kelly Md NPPES

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

DR. BRIAN D KELLY MD (NPI 1053637736) is an individual sports medicine provider in Phoenix, Arizona, licensed in Arizona (50745) and active in the NPI registry since April 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053637736

Entity TypeIndividualMale

Primary Taxonomy2080S0010X

Provider Legal NameDR. BRIAN D KELLYCredential: MD

Location Address1919 E THOMAS RDPhoenix, AZ 85016-7710

Mailing Address1919 E Thomas RdPhoenix, AZ 85016-7710 · (602) 933-3033 · Fax (602) 933-5245

Phone(602) 933-3033

Fax(602) 933-5245

Sole ProprietorNo

Enumeration DateApril 20, 2010

Last NPPES UpdateJanuary 11, 2023

NPPES CertifiedJanuary 11, 2023

✔ NPI 1053637736 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080S0010X

License✔ Licensed in AZ · 50745

Definition

A pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

Also ListedPediatricsTaxonomy 208000000X · License 50745 (AZ), 258848 (MA)

1919 E THOMAS RD, Phoenix, AZ 85016

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Other Identifiers 1

Medicaid040502AZ

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. Brian D 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.

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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.

DR. TIMUR RAGHIB M.D.

Hospitalist