Individual provider Active NPI

Philip A Fleury, ANP

  • Adult Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1144230285
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
081001212N3 Issued in OR
Practice address
4610 SE Belmont
Suite 60
Portland, OR 97215
Phone
(503) 988-5303
Fax
(503) 988-5112
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 081001212N3 OR Primary

Addresses

Primary practice location

4610 SE Belmont
Suite 60
Portland, OR 97215

Mailing address

2623 NE 24TH Ave
Portland, OR 97212-4833
Phone (503) 287-7472

Other identifiers 1

IdentifierTypeStateIssuer
067959MedicaidOR

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

State licenses

LicenseStateTypeSpecialty
081001212N3ORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Housecall Providers Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144230285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 NE 24TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124833",
            "telephone_number": "503-287-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 SE BELMONT",
            "address_2": "SUITE 60",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97215",
            "telephone_number": "503-988-5303",
            "fax_number": "503-988-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEURY",
        "first_name": "PHILIP",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "081001212N3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.