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Deactivated NPI 1033140470 Deactivated / Inactive NPI Male Practitioner

Dr. Thomas M. L. Kelly , EdD

Psychologist • Grapevine, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Thomas Kelly has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 05, 2006
NPI Deactivation Date September 11, 2024
Total Practice Duration ~18 Years of Practice (2006 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Thomas Kelly, EdD was a registered Psychologist practicing in Grapevine, TX. Throughout an active medical career spanning 18 years, Dr. Kelly provided care at the practice location at 625 W COLLEGE ST until profile deactivation on 2024-09-11.

Historical Medicare Part B clinical services included psychotherapy, psychiatric diagnostic evaluation. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

625 W College St
Suite 109

Grapevine, TX 760515283

Telephone 8174816951
Associated Practice Facility / Clinic
🏢 Thomas M.l. Kelly, Ed.d., Pa Facility NPI 1720024532

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist in Grapevine, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 22.7 Yrs
State Avg: 22.8 Yrs
Regional Practice Density
12 Specialists

Practicing in Grapevine, TX (2266 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
1.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
90837 Psychotherapy, 60 minutes
168 21 $140.00 $138.96
90791 Psychiatric diagnostic evaluation
11 11 $150.00 $148.25

Medical Specialties & State Licenses

Psychologist Primary Specialty

NUCC Taxonomy Code: 103T00000X

State License TX 22126

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1649264078

Doctor of Education (Ed.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 11, 2024

Record deactivated on September 11, 2024

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 09, 2007

Registered at 625 W COLLEGE ST, SUITE 109, GRAPEVINE, TX 760515283 (Tel: 8174816951)

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Updated Business Mailing Address July 09, 2007

Registered at 625 W COLLEGE ST, SUITE 109, GRAPEVINE, TX 760515283 (Tel: 8174816951)

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Provider Name / Credentials Updated July 09, 2007

Recorded as THOMAS KELLY, ED.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Psychologist (License #22126 in TX)

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Initial NPI Registration & Enumeration July 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1033140470
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 05, 2006
Last Update: July 09, 2007
Deactivation Date: September 11, 2024

Mailing Address

625 W College St, Suite 109

Grapevine, TX 760515283

Phone: 8174816951

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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