Active NPI
Lorae D. Phelan, RN,MS,CS
- Psychiatric/Mental Health Nurse Practitioner
- Bedford, MA
National Provider Identifier
1609882380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 163625
- Practice address
- 110 Great Rd
Suite 205
Bedford, MA 01730-2729 - Phone
- (617) 529-7772
- Fax
- (781) 687-2018
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 163625 | MA | Primary |
Addresses
Primary practice location
110 Great Rd
Suite 205
Bedford, MA 01730-2729
Mailing address
100 Woodland Rd
Malden, MA 02148-1135
Phone (781) 388-2394
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163625 | Other | MA | TUFTS INSURANCE |
| PN0762 | Other | MA | BLUE CROSS/BLUE SHIELD IN |
| 013504 | Other | MA | PACIFICARE INSUR |
| 113345 | Other | MA | INSURANCE |
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
- Master of Science, Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609882380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 WOODLAND RD",
"city": "MALDEN",
"state": "MA",
"postal_code": "021481135",
"telephone_number": "781-388-2394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 GREAT RD",
"address_2": "SUITE 205",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017302729",
"telephone_number": "617-529-7772",
"fax_number": "781-687-2018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "LORAE",
"middle_name": "D.",
"credential": "RN,MS,CS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MA",
"license": "163625",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS INSURANCE",
"identifier": "163625",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD IN",
"identifier": "PN0762",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE INSUR",
"identifier": "013504",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSURANCE",
"identifier": "113345",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.