Edward J Phillips, CYC, CIT-HS-00158

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1521 Merrill Drive
Ste D220
Little Rock, AR 72211

Phone

(501) 666-8686

Fax

(501) 660-6830

NPI assigned

Nov 9, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Edward J Phillips Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1467118075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251970",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72225",
            "telephone_number": "501-666-8686",
            "fax_number": "501-660-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 MERRILL DRIVE",
            "address_2": "STE D220",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72211",
            "telephone_number": "501-666-8686",
            "fax_number": "501-660-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "EDWARD",
        "middle_name": "J",
        "credential": "CYC, CIT-HS-00158",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-09",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AR",
            "license": "CIT-HS-00158",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDWARD",
            "last_name": "PHILLIPS",
            "middle_name": "J",
            "prefix": "MR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Charles Edgar Phillips, M.D.
• Cheryl Amanda Phillips, RDN
• Dana Lynn Phillips, APN
• Dennis Phillips
• Douglas Brent Phillips, ATC
• Emilee Erin Phillips, MS, RD, LD
• Hannah M Phillips, M.D.
• James Phillips, MD
• Jessica Michelle Phillips, OTR/L
• John Raymond Phillips, LAC

• Case Manager/Care Coordinator in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.