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Medicare enrollment lookup

One provider matched this enrollment ID.

Enrollment ID I20040103000002 resolves to a single NPI record. Open the full profile for complete detail.

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GK
NPI · 1407820939 · Active
Garrett Kelly MD
Family Medicine · Virginia Beach, Virginia
Active
NPI
1407820939
Enrollment ID
I20040103000002
Taxonomy
207Q00000X
Type
Practitioner - Family Practice

Medicare enrollment

This provider holds a Medicare enrollment on file with the Provider Enrollment, Chain and Ownership System (PECOS). Each enrollment carries a public Medicare Enrollment ID (ENRLMT_ID) used by billers and intermediaries.

Practitioner

Source: CMS PECOS public enrollment file.

Secondary identifiers

Additional identifiers this provider has registered with NPPES. Used by medical billers, credentialers, and insurance verifiers to cross-reference claims and enrollments.

Other

  • 171965VA· Issued by ANTHEM
  • 541595397VA· Issued by MID ATLANTIC SOLUTIONS
  • 122066VA· Issued by SENTARA/OPTIMA
  • 541595397VA· Issued by CIGNA
  • 541595397VA· Issued by PRIVATE HEALTHCARE SYSTEM
  • 4084676VA· Issued by AETNA
  • 541595397VA· Issued by VIRGINIA HEALTH NETWORK

Medicaid

Source: NPPES public registry.

ReferenceAbout Medicare Enrollment IDs

A Medicare Enrollment ID (ENRLMT_ID) is a 15-character public identifier assigned by the CMS Provider Enrollment, Chain and Ownership System (PECOS) when a provider, supplier, or organisation enrols in Medicare. Each row reflects one enrolment record: a single NPI can hold multiple enrolments across provider types, states, or supplier categories. Data here is mirrored from the quarterly public PECOS enrolment file published on data.cms.gov.