EVAN KELLY MD
NPI 1124478458
Surgery in Crosby, MN

Q: What is Evan Kelly's NPI number?

The NPI number for Evan Kelly is 1124478458. It was assigned to this individual provider in the NPPES registry on June 17, 2016.

Q: What is Evan Kelly's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Evan Kelly was last updated on November 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.

Active since June 17, 2016PECOS EnrolledAccepts Medicare Assignment

320 EAST MAIN ST, CROSBY, MN 56441(218) 546-7000(218) 546-4400 Get Directions Write a Review

NPPES record last updated: November 6, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 6, 2025, Jan 13, 2023, Oct 20, 2016 and 1 more (4 updates tracked since 2016).

On this page

About Evan Kelly Md NPPES

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

EVAN KELLY MD (NPI 1124478458) is an individual surgery provider in Crosby, Minnesota, licensed in Minnesota (69041) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS, is affiliated with Riverwood Healthcare Center, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1124478458

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameEVAN KELLYCredential: MD

Location Address320 EAST MAIN STCrosby, MN 56441

Mailing Address320 East Main StCrosby, MN 56441 · (218) 546-7000 · Fax (218) 546-4400

Phone(218) 546-7000

Fax(218) 546-4400

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateJune 17, 2016

Last NPPES UpdateNovember 6, 20254 updates tracked since enumeration

NPPES CertifiedNovember 6, 2025

✔ NPI 1124478458 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

Licenses✔ Licensed in MN · 69041✔ Licensed in KY · 56579

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License TP 00013351 (CO)

320 EAST MAIN ST, Crosby, MN 56441

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, Medica.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Evan Kelly Md 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 ID6709164809

PECOS Enrollment IDI20210823000887

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.

Hospital Affiliations CMS Care Compare 2

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

Riverwood Healthcare Center

Critical Access Hospitals · Aitkin, MN

OwnershipVoluntary non-profit - Private

CMS Certification Number241305

Location200 Bunker Hill DriveAitkin, MN 56431 · Aitkin County

Emergency services

Cuyuna Regional Medical Center

Critical Access Hospitals · Crosby, MN

OwnershipGovernment - Hospital District or Authority

CMS Certification Number241353

Location320 East Main StreetCrosby, MN 56441 · Crow Wing County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 56441 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

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$69.74 typical visit price

range $18.32 – $138.04

Typical copayment $17.43 (range $4.58 – $34.51)

Most-billed visit code 99213

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.

MITCHELL J MIMBACH PA

Physician Assistant