Dr Kristopher John Kelly, DDS is a medicare enrolled "Dentist - General Practice" provider in Kyle, South Dakota. His current practice location is
1000 Health Center Road, Kyle, South Dakota. You can reach out to his office (for appointments etc.) via phone at
(605) 455-8025.
Dr Kristopher John Kelly is licensed to practice in Iowa (license number 6484) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053354258.
Healthcare Provider's Profile
| Full Name | Dr Kristopher John Kelly |
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| Gender | Male |
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| Speciality | Dentist - General Practice |
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| Location | 1000 Health Center Road, Kyle, South Dakota |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1053354258
- Provider Enumeration Date: 06/14/2006
- Last Update Date: 12/28/2016
Medicare PECOS Information:
- PECOS PAC ID: 0244529618
- Enrollment ID: I20170329000811
Medical Identifiers
Medical identifiers for Dr Kristopher John Kelly such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1053354258 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223G0001X | Dentist - General Practice | 6484 (Iowa) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kristopher John Kelly allows following entities to bill medicare on his behalf.
| Entity Name | Pine Ridge Indian Health Service Hospital |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1003963497
PECOS PAC ID: 7214825371
Enrollment ID: O20040309001203 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kristopher John Kelly is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Kristopher John Kelly, DDS
1000 Health Center Road,
Kyle, SD 57752-0540
Ph: (605) 455-8025 | Dr Kristopher John Kelly, DDS
1000 Health Center Road,
Kyle, SD 57752-0540
Ph: (605) 455-8025 |
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