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JAMES M KELLY M.D.
NPI 1104861343
Family Medicine in Ephrata, PA

Active since June 19, 2006PECOS EnrolledAccepts Medicare Assignment
101 LARKSPUR LANE, EPHRATA, PA 17522(717) 738-0660(717) 738-0658 Get Directions Write a Review

NPPES record last updated: August 28, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About James M Kelly M.d. NPPES

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

JAMES M KELLY M.D. (NPI 1104861343) is an individual family medicine provider in Ephrata, Pennsylvania, licensed in Pennsylvania (MD428418) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Lancaster General Hospital, and maintains a secondary practice location in Ephrata.

NPPES Registry Identity

NPI1104861343
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJAMES M KELLYCredential: M.D.
Location Address101 LARKSPUR LANEEphrata, PA 17522-8402
Mailing Address101 Larkspur LaneEphrata, PA 17522-8402 · (717) 738-0660 · Fax (717) 738-0658
Phone(717) 738-0660
Fax(717) 738-0658
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateJune 19, 2006
Last NPPES UpdateAugust 28, 2025
NPPES CertifiedAugust 28, 2025
✔ NPI 1104861343 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in PA · MD428418
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
101 LARKSPUR LANE, Ephrata, PA 17522
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Secondary Practice Location 1

Location 11635 W Main St, Suite 700Ephrata, PA 17522-1119 · Phone (717) 738-0660 · Fax (717) 738-0658

Other Identifiers 11

Other50061893PA · Capital Blue Cross
Other7276819PA · Aetna Non-hmo
Other1874597PA · Highmark Blue Shield
Other50065832PA · Capital Blue Cross
Other50061968PA · Capital Blue Cross
Other50060203PA · Capital Blue Cross
Medicaid1016458260001PA
Other107754 S1QFPA · Geisinger Health Plan
Other1429961PA · Aetna Hmo
OtherI54742PA · Health Assurance
OtherP008054PA · Gateway Health Plan

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.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

James M 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 ID9335152727
PECOS Enrollment IDI20060802000117
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 James Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lancaster General Medical Group
4.3 mi
Urgent Care
895 EAST MAIN STREET
Ephrata, PA 17522
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 727 clinicians in this Medicare group
NPI 1295000719 (717) 721-4585
Lancaster General Health - Columbia Center
19 mi
Family Medicine
306 N 7TH ST
Columbia, PA 17512
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 52 clinicians in this Medicare group
NPI 1700972338 (717) 684-9106

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

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
365 services180 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
69 services68 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
62 services61 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
60 services60 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
49 services46 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
37 services19 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Lancaster General Hospital

Acute Care Hospitals · Lancaster, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390100
Location555 North Duke StreetLancaster, PA 17602 · Lancaster County
Emergency services Birthing friendly

Wellspan Ephrata Community Hospital

Acute Care Hospitals · Ephrata, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390225
Location169 Martin AvenueEphrata, PA 17522 · Lancaster County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 17522 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
$84.88 typical visit price
range $54.64 – $166.87
Typical copayment $21.22 (range $13.66 – $41.71)
Most-billed visit code 99203
Established Patient
$96.82 typical visit price
range $17.33 – $135.84
Typical copayment $24.20 (range $4.33 – $33.96)
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 9

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

Supplies for maintenance of insulin infusion catheter, per week A4224
DME-Other DME · category DE017N
3 suppliers11 claims143 services$18.26 avg. paid by Medicare
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each A4225
DME-Other DME · category DE017N
3 suppliers11 claims390 services$2.36 avg. paid by Medicare
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
11 suppliers35 claims95 services$5.55 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
6 suppliers14 claims20 services$0.91 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
2 suppliers11 claims11 services$35.29 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
2 suppliers14 claims14 services$57.36 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 3

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

JESSICA JACQUELINE GILLIS CRNP
Nurse Practitioner (Family)
101 LARKSPUR LANE
EPHRATA, PA 17522
Lancaster County (717) 738-0660
ELIZABETH JANE RUHL CRNP
Nurse Practitioner
101 LARKSPUR LANE
EPHRATA, PA 17522
Lancaster County (717) 738-0660
BRANDI MARIE YODER CRNP, FNP-C
Nurse Practitioner (Family)
101 LARKSPUR LANE
EPHRATA, PA 17522
Lancaster County (717) 738-0660

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 James Kelly's NPI number?

The NPI number for James Kelly is 1104861343. It was assigned to this individual provider in the NPPES registry on June 19, 2006.

Where is James Kelly located?

James Kelly practices at 101 Larkspur Lane, Ephrata, PA 17522. The listed phone number is (717) 738-0660.

What is James Kelly's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is James Kelly enrolled in Medicare?

Yes. James 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 James Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), James Kelly reassigns Medicare benefits to 2 organizations: Lancaster General Medical Group (Ephrata, PA) and Lancaster General Health - Columbia Center (Columbia, PA). 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 James Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does James Kelly accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list James 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.

Is James Kelly affiliated with any hospitals?

According to CMS data, James Kelly is affiliated with Lancaster General Hospital and Wellspan Ephrata Community Hospital.

When was this NPI record last updated?

The NPPES record for James Kelly was last updated on August 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.