Active NPI
Charlotte Sue Phillips, M.D.
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1073690939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 103182
- Practice address
- 335 Central Ave
Brooklyn, NY 11221-4501 - Phone
- (718) 573-4860
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 103182 | NY | Primary |
Addresses
Primary practice location
335 Central Ave
Brooklyn, NY 11221-4501
Mailing address
18 Wyckoff St
Brooklyn, NY 11201-6306
Phone (718) 624-5828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10318201 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170912000313 | NY | Order and Referring Only - Pediatric Medicine | 6800077223 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103182 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073690939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WYCKOFF ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112016306",
"telephone_number": "718-624-5828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 CENTRAL AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112214501",
"telephone_number": "718-573-4860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "CHARLOTTE",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "103182",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10318201",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.