| Lawrence J Kelly, MD | |
|
12361 W Bola Dr, Suite 100, Surprise, AZ 85378-9021 | |
| (623) 584-5626 | |
| (623) 584-8998 |
| Full Name | Lawrence J Kelly |
|---|---|
| Gender | Male |
| Speciality | Orthopedic Surgery |
| Experience | 35 Years |
| Location | 12361 W Bola Dr, Surprise, Arizona |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124014758 | NPI | - | NPPES |
| 5920416 | Other | AZ | AETNA |
| P00188666 | Other | AZ | RAILROAD MEDICARE |
| 2036792 | Other | AZ | UNITED HEALTHCARE |
| 2Z1651 | Other | AZ | HEALTHNET |
| 1124014758 | Other | AZ | AHCCCS |
| P0836100 | Other | AZ | BCBS OUT OF AREA |
| 514829 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | 27172 (Arizona) | Primary |
| 207XX0005X | Orthopaedic Surgery - Sports Medicine | 35083 (Arizona) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Banner Boswell Medical Center | Sun city, AZ | Hospital |
| Banner Del E. Webb Medical Center | Sun city west, AZ | Hospital |
| Banner Estrella Medical Center | Phoenix, AZ | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Bhsm Rehabilitation Llc | 2062773138 | 1575 |
| Banner Physician Specialists Arizona Llc | 6204002272 | 234 |
| Entity Name | Banner Physician Specialists Arizona Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316228802 PECOS PAC ID: 6204002272 Enrollment ID: O20111222000509 |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence J Kelly, MD 12361 W Bola Dr, Suite 100, Surprise, AZ 85378-9021 Ph: (623) 584-5626 | Lawrence J Kelly, MD 12361 W Bola Dr, Suite 100, Surprise, AZ 85378-9021 Ph: (623) 584-5626 |
David A Rand, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 14780 W Mountain View Blvd Ste 110, Surprise, AZ 85374 Phone: 623-374-7774 Fax: 855-420-6361 | |
Martin G Sterusky, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 12361 W Bola Dr, Suite100, Surprise, AZ 85378 Phone: 623-584-5626 Fax: 623-584-8998 | |
Robert C Waldrip, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 12361 W Bola Dr, Suite 100, Surprise, AZ 85378 Phone: 623-584-5626 Fax: 623-544-9122 |