KELLYA ANNISA UBOKUDOM DO
NPI 1104213164
Emergency Medicine - Pediatric Emergency Medicine in Ann Arbor, MI

Active since April 16, 2015PECOS Enrolled
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109(734) 936-4000 Get Directions Write a Review

NPPES record last updated: November 7, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 7, 2022, Nov 4, 2022, Apr 22, 2022 and 2 more (5 updates tracked since 2021).

About Kellya Annisa Ubokudom Do NPPES

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

KELLYA ANNISA UBOKUDOM DO (NPI 1104213164) is an individual pediatric emergency medicine provider in Ann Arbor, Michigan, licensed in Michigan (5101021815) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS and maintains a secondary practice location in Cleveland.

NPPES Registry Identity

NPI1104213164
Entity TypeIndividualFemale
Primary Taxonomy207PP0204X
Provider Legal NameKELLYA ANNISA UBOKUDOMCredential: DO
Location Address1500 E MEDICAL CENTER DRAnn Arbor, MI 48109-5000
Mailing Address3621 S State StAnn Arbor, MI 48108-1633 · (734) 647-5299
Sole ProprietorNo
Enumeration DateApril 16, 2015
Last NPPES UpdateNovember 7, 20225 updates tracked since enumeration
NPPES CertifiedNovember 7, 2022
NPI 1104213164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

Primary SpecialtyEmergency Medicine · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207PP0204X
License Licensed in MI · 5101021815
Definition

Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department.

Also ListedEmergency MedicineTaxonomy 207P00000X · License 34013380 (OH)
Also ListedPediatricsTaxonomy 208000000X · License 5101021815 (MI)
1500 E MEDICAL CENTER DR, Ann Arbor, MI 48109

Secondary Practice Location 1

Location 1500 Euclid Ave E19Cleveland, OH 44195-2664 · Phone (216) 445-9175 · Fax (216) 445-4552

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Kellya Annisa Ubokudom Do 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48109 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
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$102.35 typical visit price
range $18.32 – $143.49
Typical copayment $25.58 (range $4.58 – $35.87)
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.

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.

Pathology (Forensic Pathology)
1500 E MEDICAL CENTER DR, 2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY
ANN ARBOR, MI 48109
Internal Medicine (Gastroenterology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Pathology (Cytopathology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Pediatrics
1500 E MEDICAL CENTER DR, 12TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL ROOM 525
ANN ARBOR, MI 48109
Pediatrics (Pediatric Infectious Diseases)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Physician Assistant
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Nurse Anesthetist, Certified Registered
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Family Medicine (Hospice and Palliative Medicine)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109

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 Kellya Ubokudom's NPI number?

The NPI number for Kellya Ubokudom is 1104213164. It was assigned to this individual provider in the NPPES registry on April 16, 2015.

Where is Kellya Ubokudom located?

Kellya Ubokudom practices at 1500 E Medical Center Dr, Ann Arbor, MI 48109. The listed phone number is (734) 936-4000.

What is Kellya Ubokudom's specialty?

The primary specialty registered for this NPI is Emergency Medicine, specializing in Pediatric Emergency Medicine, with taxonomy code 207PP0204X.

Is Kellya Ubokudom enrolled in Medicare?

Yes. Kellya Ubokudom is registered in the Medicare PECOS enrollment system.

What insurance does Kellya Ubokudom accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 1 other insurer list Kellya Ubokudom 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 Kellya Ubokudom was last updated on November 7, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.