Individual provider Active NPI

Phylicia F Fleming, PHD, NCSP

  • Psychologist
  • Philadelphia, PA
National Provider Identifier
1326696535
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS019763 Issued in PA
Practice address
4601 Market St
Philadelphia, PA 19139-4636
Phone
(215) 590-7555
NPI assigned
Aug 30, 2019
Last updated
Mar 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2024047158 MO
Psychologist 103T00000X PS019763 PA Primary

Addresses

Primary practice location

4601 Market St
Philadelphia, PA 19139-4636

Mailing address

2716 South St # 8322
Philadelphia, PA 19146-2305
Phone (601) 291-9504

Other practice location 1

1 Childrens Pl Ste 3N-14
Saint Louis, MO 63110-1002
Phone (314) 454-6069

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE) St. Louis Childrens Hospital

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250402001617 MO Practitioner - Clinical Psychologist 8022531896 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2024047158MOMDPsychologist
PS019763PAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
St Louis Childrens Hospital CurrentSince Jan 4, 2025 Accepting new patients
St. Louis Childrens Hospital CurrentSince Jan 4, 2025 Accepting new patients
St. Louis Childrens Hospital Past Accepting new patients

Locations

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

1 Childrens Pl
Ste 3N14
Saint Louis, MO 63110
Phone (314) 454-6069

5114 Mid America Plz
Ste 3C
Saint Louis, MO 63129
Phone (314) 454-5437

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1567123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1326696535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 SOUTH ST # 8322",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191462305",
            "telephone_number": "601-291-9504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 MARKET ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191394636",
            "telephone_number": "215-590-7555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Pl Ste 3N-14",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-6069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLEMING",
        "first_name": "PHYLICIA",
        "middle_name": "F",
        "credential": "PHD, NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-30",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2024047158",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS019763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "endpointDescription": "BJC",
            "affiliationName": "St. Louis Childrens Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Childrens Pl Ste 3N-14",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.