Active NPI
Phil T Porter, PSYCHOLOGIST
- Psychologist
- Oskaloosa, IA
National Provider Identifier
1013931187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 00095
- Practice address
- 1229 C Ave E
#300
Oskaloosa, IA 52577-4246 - Phone
- (641) 672-3159
- Fax
- (641) 672-3259
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 00095 | IA | Primary |
Addresses
Primary practice location
1229 C Ave E
#300
Oskaloosa, IA 52577-4246
Mailing address
1229 C Avenue East
#300
Oskaloosa, IA 52577
Phone (641) 672-3159
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00095 | IA | MD | Clinical Social Worker |
| 95 | IA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013931187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1229 C AVENUE EAST",
"address_2": "#300",
"city": "OSKALOOSA",
"state": "IA",
"postal_code": "52577",
"telephone_number": "641-672-3159",
"fax_number": "641-672-3259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1229 C AVE E",
"address_2": "#300",
"city": "OSKALOOSA",
"state": "IA",
"postal_code": "525774246",
"telephone_number": "641-672-3159",
"fax_number": "641-672-3259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "PHIL",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IA",
"license": "00095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oskaloosa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.