Active NPI
Kelley L Phillips, KELLEY PHILLIPS MD
- Psychiatry Physician
- Colorado Springs, CO
National Provider Identifier
1124062443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- DR.0061894
- Practice address
- 875 W Moreno Ave
Colorado Springs, CO 80905-1731 - Phone
- (719) 572-6100
- NPI assigned
- Jun 16, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD13012 | DC | |
| Psychiatry Physician | 2084P0800X | DR.0061894 | CO | Primary |
Addresses
Primary practice location
875 W Moreno Ave
Colorado Springs, CO 80905-1731
Mailing address
3322 Dent PL NW
Washington, DC 20007-2712
Phone (202) 337-8051
Other practice location 1
3322 Dent Pl NW
Washington, DC 20007-2712
Phone (202) 337-8051
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 185693 | Other | VA | BCBS VA |
| P00479398 | Other | ND | RR MEDICARE ND |
| 010206758 | Medicaid | VA | |
| 0488015 | Medicaid | IA | |
| P00384921 | Other | DC | RR MEDICARE X |
| P00384921 | Other | DE | RR MEDICARE S |
| 13831 | Medicaid | ND | |
| 60484701 | Other | MD | BCBS MD |
| 410407200 | Medicaid | MD | |
| G396-0044 | Other | DC | BCBS DC |
| P00356148 | Other | IA | RR MEDICARE IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR.0061894 | CO | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rutland Hospital, Inc. | Past | Accepting new patients | |
| Medop Behavioral Health Associates of Maryland PC | Psychiatry | Past | Accepting new patients |
| T Med Behavioral Inc | Psychiatry | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Psychiatry Physician
- Baltimore, MD
- NPI 1447203963
-
- General Acute Care Hospital
- Rutland, VT
- NPI 1720042203
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1124062443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3322 DENT PL NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200072712",
"telephone_number": "202-337-8051",
"fax_number": "202-338-4436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 W MORENO AVE",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809051731",
"telephone_number": "719-572-6100"
}
],
"practiceLocations": [
{
"address_1": "3322 Dent Pl NW",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "200072712",
"country_code": "US",
"telephone_number": "202-337-8051",
"fax_number": "202-338-4436",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "KELLEY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "KELLEY PHILLIPS MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "DC",
"license": "MD13012",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "DR.0061894",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS VA",
"identifier": "185693",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE ND",
"identifier": "P00479398",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010206758",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0488015",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE X",
"identifier": "P00384921",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE S",
"identifier": "P00384921",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13831",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MD",
"identifier": "60484701",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "410407200",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DC",
"identifier": "G396-0044",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE IA",
"identifier": "P00356148",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.