Individual provider Active NPI

Carmen Phillips

  • Family Nurse Practitioner
  • Somerville, MA
National Provider Identifier
1013328210
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN251726 Issued in MA
Practice address
260 Elm St
Somerville, MA 02144-2951
Phone
(617) 666-9577
NPI assigned
May 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN251726 MA Primary

Addresses

Primary practice location

260 Elm St
Somerville, MA 02144-2951

Mailing address

33 Westminster Ave
Arlington, MA 02474-2732
Phone (617) 953-7250

Other identifiers 1

IdentifierTypeStateIssuer
RN251726OtherMAMA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140707001643 MA Practitioner - Nurse Practitioner 4981829959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Davis Square Family PracticeGroup PAC ID 1355385196, 6 clinicians

Practice addresses (Care Compare)

255 Elm St
Suite 301
Somerville, MA 02144-2947
Phone (617) 666-9577

Hospital & facility affiliations

  • Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN251726MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Davis Square Family Practice CurrentSince Nov 16, 2017 Accepting new patients

Locations

260 Elm St
Somerville, MA 02144
Phone (617) 666-9577

255 Elm St
Ste 301
Somerville, MA 02144
Phone (617) 666-9577

Interoperability endpoints

  • Direct secure messaging: cphillips23036@direct.bilh.masshiway.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1013328210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 WESTMINSTER AVE",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024742732",
            "telephone_number": "617-953-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 ELM ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442951",
            "telephone_number": "617-666-9577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CARMEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-12",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN251726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA LICENSE",
            "identifier": "RN251726",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

Verify at the official NPI Registry.