Active NPI
Elaine Roland Phillips, MD
- Student in an Organized Health Care Education/Training Program
- Santa Cruz, CA
National Provider Identifier
1083461164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1555 Soquel Dr
Santa Cruz, CA 95065-1705 - Phone
- (831) 462-7700
- NPI assigned
- May 6, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14582 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1555 Soquel Dr
Santa Cruz, CA 95065-1705
Mailing address
1411 E 31St St FL 2
Oakland, CA 94602-1018
Phone (510) 437-4401
Other practice location 1
1411 E 31st St Fl 2
Oakland, CA 94602-1018
Phone (510) 437-4401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20250605002284 | CA | Order and Referring Only - Family Practice | 6103335591 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746576000000",
"number": "1083461164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 E 31ST ST FL 2",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021018",
"telephone_number": "510-437-4401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 SOQUEL DR",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950651705",
"telephone_number": "831-462-7700"
}
],
"practiceLocations": [
{
"address_1": "1411 E 31st St Fl 2",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946021018",
"country_code": "US",
"telephone_number": "510-437-4401",
"fax_number": "510-535-7313",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "ELAINE",
"middle_name": "ROLAND",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-06",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "14582",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.