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EVAN KELLY MD
NPI 1124478458
Surgery in Crosby, MN

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: October 25, 2026.

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

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
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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

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.

Medicare Billing Reassignments

2

Medicare enrollment records show Evan Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Cuyuna Regional Medical Center
0.6 mi
Critical Access
320 E MAIN ST
Crosby, MN 56441
  • Reassigned Medicare billing, Minnesota enrollment
  • 224 clinicians in this Medicare group
NPI 1538143896 (218) 546-7000
Aitkin Community Hospital, Inc.
12 mi
Critical Access
200 BUNKER HILL DR
Aitkin, MN 56431
  • Reassigned Medicare billing, Minnesota enrollment
  • 164 clinicians in this Medicare group
NPI 1942277835 (218) 927-2121

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

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
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
ABBY L DINGMANN PA-C
Physician Assistant
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
MONICA K LARSON FNP-C
Nurse Practitioner (Family)
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
SHANNON M SICARD APRN, CRNA
Nurse Anesthetist, Certified Registered
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
BRITTA RAE PETERSON APRN, CRNA
Nurse Anesthetist, Certified Registered
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
BRADLEY E GUSTAFSON MD
Internal Medicine
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
BRITTANY ROY CRNA
Nurse Anesthetist, Certified Registered
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000
PAIGE ASHLEY KANE PA-C
Physician Assistant
320 EAST MAIN ST
CROSBY, MN 56441
Crow Wing County (218) 546-7000

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 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.

Where is Evan Kelly located?

Evan Kelly practices at 320 East Main St, Crosby, MN 56441. The listed phone number is (218) 546-7000.

What is Evan Kelly's specialty?

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

Is Evan Kelly enrolled in Medicare?

Yes. Evan 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 Evan Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Evan Kelly reassigns Medicare benefits to 2 organizations: Cuyuna Regional Medical Center (Crosby, MN) and Aitkin Community Hospital, Inc. (Aitkin, MN). 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 Evan Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Evan Kelly affiliated with any hospitals?

According to CMS data, Evan Kelly is affiliated with Riverwood Healthcare Center and Cuyuna Regional Medical Center.

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 11 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.