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JACQUELINE KELLY M.D.
NPI 1104169283
Internal Medicine in Boise, ID

Active since March 27, 2013PECOS EnrolledAccepts Medicare Assignment
500 W FORT ST # 111, BOISE VAMC, BOISE, ID 83702(208) 422-1314 Get Directions Write a Review

NPPES record last updated: December 21, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jacqueline Kelly M.d. NPPES

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

JACQUELINE KELLY M.D. (NPI 1104169283) is an individual internal medicine provider in Boise, Idaho, licensed in Idaho (MRM-1350) and active in the NPI registry since March 2013. She is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1104169283
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameJACQUELINE KELLYCredential: M.D.
Location Address500 W FORT ST # 111, BOISE VAMCBoise, ID 83702-4501
Mailing Address500 W Fort St # 111, Boise VamcBoise, ID 83702-4501
Phone(208) 422-1314
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateMarch 27, 2013
Last NPPES UpdateDecember 21, 2021
✔ NPI 1104169283 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in ID · MRM-1350
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
500 W FORT ST # 111, Boise, ID 83702
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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

Jacqueline Kelly M.d. 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 ID941520076
PECOS Enrollment IDI20161031002040
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 Reassignment

Medicare enrollment records show Jacqueline Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
470 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83702 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$121.27 typical visit price
range $52.44 – $160.17
Typical copayment $30.31 (range $13.11 – $40.04)
Most-billed visit code 99204
Established Patient
$93.26 typical visit price
range $16.68 – $130.93
Typical copayment $23.31 (range $4.17 – $32.73)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier12 claims12 services$88.74 avg. paid by Medicare
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738
DME-Oxygen and Supplies · category DC000N
1 supplier12 claims12 services$34.23 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 13

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

SCOTT BRUNSON MD
Emergency Medicine
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1000
ALAN S. NELSON D.O.
Family Medicine
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 732-0959
MRS. JENNIFER ANN HACKWITH NP
Nurse Practitioner
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1000
JULIA S. BAILEY NP
Nurse Practitioner
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1000
LAURA POLY PA
Physician Assistant (Medical)
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1325
KATHERINE L. BURCHELL FNP-BC
Nurse Practitioner (Family)
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1000
DIANE TURNER MD
Internal Medicine
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1000
ELIZABETH DANA MORRISON MD
Internal Medicine (Gastroenterology)
500 W FORT ST # 111
BOISE, ID 83702
Ada County (208) 422-1325

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 Jacqueline Kelly's NPI number?

The NPI number for Jacqueline Kelly is 1104169283. It was assigned to this individual provider in the NPPES registry on March 27, 2013.

Where is Jacqueline Kelly located?

Jacqueline Kelly practices at 500 W Fort St # 111 Boise Vamc, Boise, ID 83702. The listed phone number is (208) 422-1314.

What is Jacqueline Kelly's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Jacqueline Kelly enrolled in Medicare?

Yes. Jacqueline 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 organization bills Medicare for Jacqueline Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Kelly reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The 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 Jacqueline Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacqueline Kelly was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.