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DR. KEVIN J KELLEHER MD
NPI 1689674202
Family Medicine in Reston, VA

Active since July 26, 2005Opted out of Medicare · through Jul 1, 2027
12040 S LAKES DR, STE 207, RESTON, VA 20191(703) 464-0686(703) 464-0698 Get Directions Write a Review

NPPES record last updated: September 10, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kevin J Kelleher Md NPPES

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

DR. KEVIN J KELLEHER MD (NPI 1689674202) is an individual family medicine provider in Reston, Virginia, licensed in Virginia (0101054571) and active in the NPI registry since July 2005. He has opted out of Medicare through July 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1689674202
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. KEVIN J KELLEHERCredential: MD
Location Address12040 S LAKES DR, STE 207Reston, VA 20191-1246
Mailing Address12040 S Lakes Dr, Ste 207Reston, VA 20191-1246 · (703) 464-0686 · Fax (703) 464-0698
Phone(703) 464-0686
Fax(703) 464-0698
Sole ProprietorNo
Enumeration DateJuly 26, 2005
Last NPPES UpdateSeptember 10, 2014
✔ NPI 1689674202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0101054571
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.
12040 S LAKES DR, Reston, VA 20191
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Other Identifiers 5

Other542011791VA · Tin
OtherG00463VA · Medicare Group
Medicare UPING35598VA
Medicare ID-Type Unspecified00A088G63VA
Medicare PIN00A088G63

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kevin J Kelleher Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2025 through July 1, 2027.

Opt-Out Effective DateJuly 1, 2025
Opt-Out In Effect ThroughJuly 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20191 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
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
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.

Other Providers at the Same Location NPPES 12

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

GENERATIONS FAMILY MEDICINE PC
Family Medicine
12040 S LAKES DR, STE 190
RESTON, VA 20191
Fairfax County (703) 464-0686
DR. JOHN P MAMANA M.D.
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
EHS CORPORATE CARE
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
MR. MARK EMANUEL VASILIADIS M.D.
Family Medicine
12040 S LAKES DR, SUITE 195
RESTON, VA 20191
Fairfax County (703) 230-0347
EXECUTIVE HEALTHCARE SERVICES PLLC
Family Medicine
12040 S LAKES DR, SUITE 195
RESTON, VA 20191
Fairfax County (703) 230-0347
LAURA LISBETH KENNEDY RN, FNP-BC
Nurse Practitioner (Family)
12040 S LAKES DR
RESTON, VA 20191
Fairfax County (703) 464-0686
DEANNA LYNN MARKLEY PA
Physician Assistant (Medical)
12040 S LAKES DR, SUITE 207
RESTON, VA 20191
Fairfax County (703) 464-0686
ARAMESH DARVISHIAN DDS
Dentist
12040 S LAKES DR, SUITE 200
RESTON, VA 20191
Fairfax County (703) 955-4440

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 Kevin Kelleher's NPI number?

The NPI number for Kevin Kelleher is 1689674202. It was assigned to this individual provider in the NPPES registry on July 26, 2005.

Where is Kevin Kelleher located?

Kevin Kelleher practices at 12040 S Lakes Dr Ste 207, Reston, VA 20191. The listed phone number is (703) 464-0686.

What is Kevin Kelleher's specialty?

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

Is Kevin Kelleher enrolled in Medicare?

No. Kevin Kelleher has opted out of Medicare through July 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Kevin Kelleher was last updated on September 10, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.