Deactivated NPI 1265430474 Deactivated / Inactive NPI Male Practitioner

Dr. Jerry R Kelley , MD

Surgery • San Antonio, TX

⚠️

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. Jerry Kelley has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 12, 2005

NPI Deactivation Date February 28, 2024

Total Practice Duration ~19 Years of Practice (2005 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Jerry Kelley, MD was a registered Surgery practicing in San Antonio, TX. Throughout an active medical career spanning 19 years, Dr. Kelley provided care at the practice location at 3519 PAESANOS PKWY until profile deactivation on 2024-02-28.

Historical Medicare Part B clinical services included subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least, removal of skin and tissue, 20.0 sq cm or less, subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

3519 Paesanos Pkwy
Suite 105

San Antonio, TX 782311264

Telephone 2105648113

Fax 2105648939

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in San Antonio, TX

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 22.2 Yrs

State Avg: 25.2 Yrs

Regional Practice Density

169 Specialists

Practicing in San Antonio, TX (2342 Statewide)

Telehealth Adoption Rate

7.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

61.2% 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
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	18	11	$170.00	$65.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11042 Removal of skin and tissue, 20.0 sq cm or less	64	15	$200.00	$122.23
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	42	12	$190.00	$88.11
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	33	15	$170.00	$66.64
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	13	13	$189.00	$86.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11042 Removal of skin and tissue, 20.0 sq cm or less	166	32	$200.00	$120.51
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	62	23	$170.00	$67.62
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	60	22	$190.00	$89.66
11042 Removal of skin and tissue, 20.0 sq cm or less	37	17	$200.00	$58.78
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	17	17	$189.00	$89.13

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11042 Removal of skin and tissue, 20.0 sq cm or less	359	67	$200.00	$116.11
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	264	67	$170.00	$67.06
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	190	48	$190.00	$89.33
11042 Removal of skin and tissue, 20.0 sq cm or less	111	34	$200.00	$60.09
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	98	18	$60.00	$40.61
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	75	32	$170.00	$66.95
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	66	65	$189.00	$87.77
17250 Application of chemical to stop tissue regrowth in wound	60	14	$171.00	$53.77
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	53	24	$190.00	$89.34
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	36	35	$93.00	$43.02
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	30	11	$60.00	$26.04
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	25	25	$189.00	$87.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
11042 Removal of skin and tissue, 20.0 sq cm or less	331	77	$200.00	$112.10
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	240	78	$170.00	$67.84
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	138	45	$190.00	$89.19
11042 Removal of skin and tissue, 20.0 sq cm or less	54	30	$200.00	$56.36
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	43	29	$170.00	$67.54
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	36	36	$189.00	$89.15
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	28	17	$275.00	$209.16
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	26	26	$189.00	$88.87
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	23	16	$93.00	$43.50
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	23	16	$190.00	$89.24

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License TX E6450

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Practice Associates & Co-Workers

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

1 Associated Practitioners

Dr. John Schmitz , DDS, PhD

Dentist - Oral and Maxillofacial Pathology

NPI 1295719508

Doctor of Dental Surgery, Doctor of Philosophy (Ph.D.)

Career & Practice History Timeline

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

17 Historical Events

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NPI Profile Deactivated February 28, 2024

Record deactivated on February 28, 2024

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NPI Profile Active March 17, 2018

NPI status registered as active in NPPES database

📍

Updated Practice Location March 17, 2018

Registered at 4499 MEDICAL DRIVE, SUB LEVEL 2, SAN ANTONIO, TX 78229 (Tel: 2105754334)

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Updated Business Mailing Address March 17, 2018

Registered at PO BOX 1716, SAN ANTONIO, TX 782961716 (Tel: 2105586288)

👤

Provider Name / Credentials Updated March 17, 2018

Recorded as JERRY KELLEY, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Preventive Medicine (License #E6450 in TX)

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NPI Profile Active January 03, 2018

NPI status registered as active in NPPES database

📍

Updated Practice Location January 03, 2018

Registered at 4499 MEDICAL DRIVE, SUB LEVEL 2, SAN ANTONIO, TX 78229 (Tel: 2105754334)

📍

Updated Business Mailing Address January 03, 2018

Registered at PO BOX 1716, SAN ANTONIO, TX 782961716 (Tel: 2105586288)

👤

Provider Name / Credentials Updated January 03, 2018

Recorded as JERRY KELLEY, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 03, 2018

Preventive Medicine (License #E6450 in TX)

✅

NPI Profile Active January 12, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location January 12, 2010

Registered at 3519 PAESANOS PKWY, SUITE 105, SAN ANTONIO, TX 782311264 (Tel: 2105648113)

📍

Updated Business Mailing Address January 12, 2010

Registered at 3519 PAESANOS PKWY, SUITE 105, SAN ANTONIO, TX 782311264 (Tel: 2105648113)

👤

Provider Name / Credentials Updated January 12, 2010

Recorded as JERRY KELLEY, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 12, 2010

Surgery (License #E6450 in TX)

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Initial NPI Registration & Enumeration July 12, 2005

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: 1265430474

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 12, 2005

Last Update: January 12, 2010

Deactivation Date: February 28, 2024

Update or Correct Profile

Mailing Address

3519 Paesanos Pkwy, Suite 105

San Antonio, TX 782311264

Phone: 2105648113

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

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.