Individual provider Active NPI

Peter C Phillips, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1184630543
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
MD043817L Issued in PA
Practice address
3401 Civic Center Blvd
Chca Hematology & Oncology
Philadelphia, PA 19104-4319
Phone
(215) 590-3535
Fax
(215) 590-3992
NPI assigned
Jul 31, 2006
Last updated
Feb 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MD043817L PA Primary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 142163 NY

Addresses

Primary practice location

3401 Civic Center Blvd
Chca Hematology & Oncology
Philadelphia, PA 19104-4319

Mailing address

100 E Penn SQ FL 9
Chca Hematology & Oncology
Philadelphia, PA 19107-3377
Phone (267) 425-9232

Other identifiers 2

IdentifierTypeStateIssuer
001008390MedicaidPA
0217409MedicaidNJ

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

LicenseStateTypeSpecialty
142163NYMDNeurology with Special Qualifications in Child Neurology Physician

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1184630543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ FL 9",
            "address_2": "CHCA HEMATOLOGY & ONCOLOGY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073377",
            "telephone_number": "267-425-9232",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHCA HEMATOLOGY & ONCOLOGY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-3535",
            "fax_number": "215-590-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "PETER",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "PA",
            "license": "MD043817L",
            "primary": true
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NY",
            "license": "142163",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001008390",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0217409",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.