Phyllis Deshun Hursey, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD26240 Issued in OR

Practice address

1206 SE 11TH Ave
Portland, OR 97214-3601

Phone

(503) 389-1166

Fax

(503) 389-1161

NPI assigned

Jan 27, 2006

Last updated

Dec 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: phyllis.hursey.p100@direct.wvp.nextgenshare.com

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.

• Pacific Mental Health Clinic LLC

  • Clinical Social Worker
  • Portland, OR
  • NPI 1699535195
  Medicare reassignment NPD
• PDH Family Medical Home

  dba PDH Family Medical

  • Clinic/Center
  • Salem, OR
  • NPI 1720305832
  Authorized official Same address or phone
• Pain GPS Clinic, LLC

  • Pain Medicine Physician
  • Eugene, OR
  • NPI 1114553229
  NPD

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1427029537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13215 SE MILL PLAIN BLVD STE C8",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846999",
            "telephone_number": "503-269-2409",
            "fax_number": "503-389-1161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 SE 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143601",
            "telephone_number": "503-389-1166",
            "fax_number": "503-389-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HURSEY",
        "first_name": "PHYLLIS",
        "middle_name": "DESHUN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD26240",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "MD26240",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE",
            "identifier": "MD26240",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connor Hurley, PT
• Samuel Hurley, CSWA
• Zina Celeste Hurley, L.AC.
• Amanda Kathleen Hurliman, MD
• Alex Huron, MD
• Nicole Hurst
• Ruth A Hurst, P.T., G.C.F.P.
• Benji Hurston
• Roberta Jean Hurt, LPN
• Alisa Nicole Hurtado

• Family Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.