Active NPI
William Rudolph Phelps, MD
- Surgery Physician
- Erie, PA
National Provider Identifier
1104827617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD018501
- Practice address
- 101 Walten Point
Erie, PA 16511 - Phone
- (814) 323-8630
- NPI assigned
- Aug 9, 2005
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD018501 | PA | Primary |
Addresses
Primary practice location
101 Walten Point
Erie, PA 16511
Mailing address
101 Walten Point
Erie, PA 16511
Phone (814) 323-8630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006381810010 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD018501 | PA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergycare, Inc | Past | Accepting new patients | |
| Regional Health Services Inc | Surgery | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Ambulance
- Erie, PA
- NPI 1033111554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1104827617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 WALTEN POINT",
"city": "ERIE",
"state": "PA",
"postal_code": "16511",
"telephone_number": "814-323-8630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 WALTEN POINT",
"city": "ERIE",
"state": "PA",
"postal_code": "16511",
"telephone_number": "814-323-8630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "WILLIAM",
"middle_name": "RUDOLPH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD018501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006381810010",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.