Miadette Pheng-Phal, NP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

RN2270203 Issued in MA

Practice address

269 Union St
Lynn, MA 01901-1314

Phone

(781) 581-3900

NPI assigned

Mar 24, 2017

Last updated

Mar 24, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bayon Medical Group, LLCGroup PAC ID 3779846241, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Shore Medical Center - Hospital, Salem, MA, CCN 220035

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: miadette.pheng-phal.1@17220.direct.athenahealth.com

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

• Bayon Medical Group LLC

  dba Lowell Primary Care Center

  • Primary Care Clinic/Center
  • Lynn, MA
  • NPI 1154866234
  Medicare reassignment Care Compare group NPD
• Lynn Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lynn, MA
  • NPI 1013997691
  Medicare reassignment NPD
• Bayon Medical Group LLC

  • Mental Health Counselor
  • Lynn, MA
  • NPI 1740769728
  NPD

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

• North Shore Medical Center, Inc.

  dba Salem Hospital

  • General Acute Care Hospital
  • Salem, MA
  • NPI 1730121633
  Care Compare affiliation

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1073044616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 UNION ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 UNION ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011314",
            "telephone_number": "781-581-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHENG-PHAL",
        "first_name": "MIADETTE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-24",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MA",
            "license": "RN2270203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Peterson, LICSW
• Shelby Petro, M.S.
• Glauce Petrone, DO
• Daniel Pfistner
• Minh Tamthi Pham, LPCA
• Phillips Manor LLC (Phillips Manor)
• Natalie T Phipps, RN
• Catherine Phothisane
• Daniel Picciotto, M.A.
• Alan Robert Piccole

• Primary Care Nurse Practitioner in Lynn, MA
• Providers in Lynn, MA by specialty
• Primary Care Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.