Active NPI
John Russell Phelps III, D.D.S., M.S.D.
- Prosthodontics
- Indianapolis, IN
National Provider Identifier
1093786147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 12009486
- Practice address
- 9011 N Meridian St
Indianapolis, IN 46260-5301 - Phone
- (317) 818-9858
- Fax
- (317) 818-1716
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 12009486 | IN | Primary |
Addresses
Primary practice location
9011 N Meridian St
Indianapolis, IN 46260-5301
Mailing address
4609 Cranbrook Dr
Indianapolis, IN 46250-2434
Phone (317) 595-0318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150507000261 | IN | Order and Referring Only - Other (Non-Physician) | 1456670868 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009486 | IN | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1093786147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4609 CRANBROOK DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502434",
"telephone_number": "317-595-0318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9011 N MERIDIAN ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605301",
"telephone_number": "317-818-9858",
"fax_number": "317-818-1716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "JOHN",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-27",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IN",
"license": "12009486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.