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JOHN JOSEPH KELLY IV MD
NPI 1174150163
Orthopaedic Surgery - Sports Medicine in Rochester, MN

Active since March 27, 2020PECOS EnrolledAccepts Medicare Assignment
200 1ST ST SW, ROCHESTER, MN 55905(507) 284-2511 Get Directions Write a Review

NPPES record last updated: August 1, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About John Joseph Kelly Iv Md NPPES

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

JOHN JOSEPH KELLY IV MD (NPI 1174150163) is an individual sports medicine provider in Rochester, Minnesota, licensed in Minnesota (79276) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Orlando, and is a graduate of State University Of Ny Upstate Medical University (2020).

NPPES Registry Identity

NPI1174150163
Entity TypeIndividualMale
Primary Taxonomy207XX0005X
Provider Legal NameJOHN JOSEPH KELLY IVCredential: MD
Location Address200 1ST ST SWRochester, MN 55905-0002
Mailing AddressPo Box 860912Minneapolis, MN 55486-0912 · (507) 284-2511
Phone(507) 284-2511
Sole ProprietorNo
Medical School CMSState University Of Ny Upstate Medical UniversityGraduated 2020
Enumeration DateMarch 27, 2020
Last NPPES UpdateAugust 1, 2025
NPPES CertifiedAugust 1, 2025
✔ NPI 1174150163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207XX0005X
License✔ Licensed in MN · 79276
Definition
An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
200 1ST ST SW, Rochester, MN 55905
Open in Google Maps ↗

Secondary Practice Location 1

Location 11222 S. Orange Avenue, 5th FL, MP#43Orlando, FL 32806 · Phone (321) 841-1764

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

John Joseph Kelly Iv 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 ID42718793
PECOS Enrollment IDI20250812001265
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.

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.

EMILY LEASURE MD
Internal Medicine
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
NATHANAEL BAILEY
Pathology (Clinical Pathology/Laboratory Medicine)
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
NICOLE S NIPPER NP
Nurse Practitioner
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
BRANDI D'SOUZA NP
Nurse Practitioner
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
DR. JODI M. MOORE-WEISS OD
Optometrist
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
JENNIFER L KERKVLIET MA
Psychologist
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
EMMANUEL J LUJERO CRNA
Nurse Anesthetist, Certified Registered
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
JUAN PABLO BRITO CAMPANA M.D
Internal Medicine (Endocrinology, Diabetes & Metabolism)
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511

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 John Kelly's NPI number?

The NPI number for John Kelly is 1174150163. It was assigned to this individual provider in the NPPES registry on March 27, 2020.

Where is John Kelly located?

John Kelly practices at 200 1st St SW, Rochester, MN 55905. The listed phone number is (507) 284-2511.

What is John Kelly's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

Is John Kelly enrolled in Medicare?

Yes. John 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.

When was this NPI record last updated?

The NPPES record for John Kelly was last updated on August 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.