Michael A Phelps, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

27450 Issued in IA

Practice address

1228 E Rusholme St
Suite 3020
Davenport, IA 52803

Phone

(563) 823-9300

Fax

(563) 823-9330

NPI assigned

Jan 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Anesthesia & Analgesia PC

  • Anesthesiology Physician
  • Davenport, IA
  • NPI 1558306381
  NPD (past)
• Genesis Health System

  • Family Medicine Physician
  • Bettendorf, IA
  • NPI 1225018211
  NPD (past)
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1073583308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 E RUSHOLME ST",
            "address_2": "SUITE 3020",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52803",
            "telephone_number": "563-823-9300",
            "fax_number": "563-823-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 E RUSHOLME ST",
            "address_2": "SUITE 3020",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52803",
            "telephone_number": "563-823-9300",
            "fax_number": "563-823-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "27450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2062455",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.phelps@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "address_1": "1228 E Rusholme St",
            "address_2": "Suite 3020",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "52803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.phelps@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1228 E Rusholme St",
            "address_2": "Suite 3020",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "52803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.phelps@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1228 E Rusholme St",
            "address_2": "Suite 3020",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "52803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Jane Peterson
• Greg Robert Peterson
• Alyssa Allyson Petroni
• Joseph M Phelan, MD
• Harriet A Phelps, PSY.D, LISW
• Nancy Lynn Phelps, LISW, LCSW
• Amanda Phillips
• Erin Phillips, CADC
• Erin Ann Phillips, OTR/L
• Lamariana Phillips

• Surgery Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Surgery Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.