Phoenix Rising Family Medicine LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

201505391NP-PP Issued in OR

Legal business name

PHOENIX RISING FAMILY MEDICINE LLC

Practice address

810 Commercial St SE
Salem, OR 97302

Phone

(971) 227-1073

NPI assigned

Jan 4, 2017

Last updated

Jul 31, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joel E DupuisNPI 1467100859

Title

MBR

Phone

(541) 556-6743

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15252/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joel Eben Dupuis, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Salem, OR
  • NPI 1467100859
  NPD Authorized official

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532995200000",
    "number": "1033654793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2693",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973082693",
            "telephone_number": "541-556-6743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "971-227-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2018-07-31",
        "status": "A",
        "authorized_official_last_name": "DUPUIS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "541-556-6743"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "201505391NP-PP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500690272",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R185124",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandi R Phillips, FNP
• Sara Phillips, PSY.D.
• Shannon Phillips, MS, LPC
• Trevor Grant Phillips, M.D.
• Phoenix Rising Counseling and Consultation
• Physicians Building Group
• Physicians Building Pharmacy Inc (Physicians Building Pharmacy)
• Deborah Piccirilli
• Chanel Pichaco
• Ashley Pickett

• Primary Care Clinic/Center in Salem, OR
• Providers in Salem, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.