Active NPI
Matthew Phillips
- Student in an Organized Health Care Education/Training Program
- Winter Park, FL
National Provider Identifier
1154164234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- TRN40675
- Practice address
- 133 Benmore Dr Ste 200
Winter Park, FL 32792-4111 - Phone
- (870) 761-7172
- NPI assigned
- Jun 17, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | TRN40675 | FL | Primary |
Addresses
Primary practice location
133 Benmore Dr Ste 200
Winter Park, FL 32792-4111
Mailing address
1545 Indiana Ave Apt C
Winter Park, FL 32789-5401
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN40675 | FL | MD | Student in an Organized Health Care Education/Training Program |
Interoperability endpoints
- mphillips3551480@adventhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718582400000",
"number": "1154164234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1545 INDIANA AVE APT C",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327895401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 BENMORE DR STE 200",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327924111",
"telephone_number": "870-761-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-17",
"last_updated": "2024-06-17",
"certification_date": "2024-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "FL",
"license": "TRN40675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.