Individual provider Active NPI

Carolyn Elisabeth Phelan, FNP

  • Family Nurse Practitioner
  • Boston, MA
National Provider Identifier
1235848029
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN2339306 Issued in MA
Practice address
930 Commonwealth Ave
Boston, MA 02215-1274
Phone
(617) 414-6800
NPI assigned
Nov 21, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2339306 MA Primary

Addresses

Primary practice location

930 Commonwealth Ave
Boston, MA 02215-1274

Mailing address

960 Massachusetts Ave Ste 2
Boston, MA 02118-2690
Phone (617) 414-5404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221228001579 MA Practitioner - Nurse Practitioner 6103296652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boston University Family Medicine IncGroup PAC ID 0446154074, 67 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 414-4465

930 Commonwealth Ave
Boston, MA 02215-1274
Phone (617) 414-6800

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2339306MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University Family Medicine, Inc. CurrentSince Dec 1, 2024 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

930 Commonwealth Ave
Boston, MA 02215
Phone (617) 262-2020

1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245

Interoperability endpoints

  • Direct secure messaging: cphelan118865@direct.bmc.masshiway.net

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1235848029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690",
            "telephone_number": "617-414-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 COMMONWEALTH AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022151274",
            "telephone_number": "617-414-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "CAROLYN",
        "middle_name": "ELISABETH",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-21",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2339306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.