Individual provider Active NPI

Kevin M Phelan, M.D.

  • Surgery Physician
National Provider Identifier
1497012488
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD210001446 Issued in DC
Practice address
51 MDG, Unit 2060
Apo, AP 96278
Phone
(505) 784-8717
NPI assigned
Apr 16, 2012
Last updated
Jun 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD210001446 DC Primary
Surgery Physician 208600000X 125.062147 IL

Addresses

Primary practice location

51 MDG, Unit 2060
Apo, AP 96278

Mailing address

900 23Rd St NW
Washington, DC 20037-2342
Phone (202) 677-6219

Other practice location 1

900 23rd St NW
Washington, DC 20037
Phone (202) 677-6219

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20230405001548 NC Practitioner - General Surgery 0446552772 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD210001446DCMDSurgery Physician
125.062147ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Specialists of Charlotte, P.a. Surgery CurrentSince May 1, 2023 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 13, 2023 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Surgery CurrentSince Mar 13, 2023 Accepting new patients
Carolinas Medical Center CurrentSince Mar 13, 2023 Accepting new patients
Carolinas Physicians Network Inc Surgery CurrentSince Mar 13, 2023 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 13, 2023 Accepting new patients
Carolinas Medical Center CurrentSince Mar 13, 2023 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

7300 Carmel Executive Park Dr
Ste 200
Charlotte, NC 28226
Phone (704) 364-8100

10030 Gilead Rd
Ste 245
Huntersville, NC 28078
Phone (704) 895-9390

441 McAlister Rd
Ste 2100
Lincolnton, NC 28092
Phone (980) 212-6250

200 W Grover St
Shelby, NC 28150
Phone (704) 487-8591

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kphelan1171516@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 10

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": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1497012488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 23RD ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200372342",
            "telephone_number": "202-677-6219",
            "fax_number": "202-741-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "51 MDG, UNIT 2060",
            "city": "APO",
            "state": "AP",
            "postal_code": "96278",
            "telephone_number": "505-784-8717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 23rd St NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "20037",
            "country_code": "US",
            "telephone_number": "202-677-6219",
            "fax_number": "202-741-3219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-16",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "DC",
            "license": "MD210001446",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.062147",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.