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EDWARD A. KELLY JR. M.D.
NPI 1235122300
Family Medicine in Downingtown, PA

Active since August 24, 2005PECOS EnrolledAccepts Medicare Assignment
75/100
CMS Quality Rating
99 MANOR AVE, DOWNINGTOWN, PA 19335(610) 269-2377(610) 269-5022 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2023, Jan 16, 2023 (2 updates tracked since 2023).

About Edward A. Kelly Jr. M.d. NPPES

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

EDWARD A. KELLY JR. M.D. (NPI 1235122300) is an individual family medicine provider in Downingtown, Pennsylvania, licensed in Pennsylvania (MD017677E) and active in the NPI registry since August 2005. He is enrolled in Medicare PECOS, is affiliated with Paoli Hospital, and is a graduate of Jefferson Medical College Of Thomas Jefferson University (1973).

NPPES Registry Identity

NPI1235122300
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameEDWARD A. KELLY JR.Credential: M.D.
Location Address99 MANOR AVEDowningtown, PA 19335-2620
Mailing Address99 Manor AveDowningtown, PA 19335-2620 · (610) 269-2377 · Fax (610) 269-5022
Phone(610) 269-2377
Fax(610) 269-5022
Sole ProprietorYes
Medical School CMSJefferson Medical College Of Thomas Jefferson UniversityGraduated 1973
Enumeration DateAugust 24, 2005
Last NPPES UpdateMarch 7, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 16, 2023
✔ NPI 1235122300 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 · MD017677E
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.
99 MANOR AVE, Downingtown, PA 19335
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Other Identifiers 4

OtherMD017677EPW · License
Medicaid0008960230004PA
Other2234277001PA · Ibc Id
Other233069058PA · Tax Id

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, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Edward A. Kelly Jr. 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 ID6901090513
PECOS Enrollment IDI20101027001322
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.

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 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.
659 services194 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
166 services128 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.
135 services120 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.
106 services106 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
88 services23 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.
38 services38 patients

Hospital Affiliations CMS Care Compare 2

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

Paoli Hospital

Acute Care Hospitals · Paoli, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390153
Location255 West Lancaster AvenuePaoli, PA 19301 · Chester County
Emergency services Birthing friendly

Chester County Hospital

Acute Care Hospitals · West Chester, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390179
Location701 East Marshall StreetWest Chester, PA 19380 · Chester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19335 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
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
100%2,087 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
1%433 patients1/55-star benchmark: 99%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
53%433 patients3/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 7

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
5 suppliers13 claims37 services$5.33 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
6 suppliers14 claims17 services$0.93 avg. paid by Medicare
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4152
Other-Enteral and Parenteral · category OB006N
3 suppliers18 claims10,663 services$0.27 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
1 supplier12 claims12 services$14.08 avg. paid by Medicare
Continuous positive airway pressure (cpap) device E0601
DME-Other DME · category DE001N
1 supplier14 claims14 services$21.79 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier11 claims11 services$67.64 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 2

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

DONNA MERKEL
Physical Therapist (Sports)
99 MANOR AVE
DOWNINGTOWN, PA 19335
Chester County (610) 518-5845
MARY S. KNISELY PT
Physical Therapist (Orthopedic)
99 MANOR AVE
DOWNINGTOWN, PA 19335
Chester County (610) 518-5845

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 Edward Kelly's NPI number?

The NPI number for Edward Kelly is 1235122300. It was assigned to this individual provider in the NPPES registry on August 24, 2005.

Where is Edward Kelly located?

Edward Kelly practices at 99 Manor Ave, Downingtown, PA 19335. The listed phone number is (610) 269-2377.

What is Edward Kelly's specialty?

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

Is Edward Kelly enrolled in Medicare?

Yes. Edward 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.

What insurance does Edward Kelly accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Edward 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 Edward Kelly affiliated with any hospitals?

According to CMS data, Edward Kelly is affiliated with Paoli Hospital and Chester County Hospital.

When was this NPI record last updated?

The NPPES record for Edward Kelly was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.