Active NPI
Paula Brutz Phelps, PA
- Medical Physician Assistant
- Pocatello, ID
National Provider Identifier
1477690899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-166
- Practice address
- 1151 Hospital Way
Suite D, Suite 201
Pocatello, ID 83201-5091 - Phone
- (208) 478-2472
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-166 | ID | Primary |
Addresses
Primary practice location
1151 Hospital Way
Suite D, Suite 201
Pocatello, ID 83201-5091
Mailing address
PO Box 4908
Pocatello, ID 83205-4908
Phone (208) 236-1600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PAJ81 | Other | ID | BCS |
| 004392500 | Medicaid | ID |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-166 | ID | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Council of Idaho, Inc. | Past | Accepting new patients |
Interoperability endpoints
- paula.phelps.1@13153.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Rigby, ID
- NPI 1710664834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1477690899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4908",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832054908",
"telephone_number": "208-236-1600",
"fax_number": "208-209-1027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1151 HOSPITAL WAY",
"address_2": "SUITE D, SUITE 201",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832015091",
"telephone_number": "208-478-2472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "PAULA",
"middle_name": "BRUTZ",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "ID",
"license": "PA-166",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCS",
"identifier": "PAJ81",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004392500",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.