Timothy Michael Phelan, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME28633 Issued in FL

Practice address

2525 Riverside Ave
Jacksonville, FL 32204-4710

Phone

(904) 388-0704

Fax

(904) 387-9095

NPI assigned

Apr 5, 2006

Last updated

Feb 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Women's Care Florida LLC

  • Obstetrics & Gynecology Physician
  • Tampa, FL
  • NPI 1013902923
  Medicare reassignment NPD
• Womens' Health Hospitalists, LLC

  • Obstetrics & Gynecology Physician
  • Tampa, FL
  • NPI 1205295599
  Medicare reassignment NPD

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1639131584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25317",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336225317",
            "telephone_number": "813-286-0033",
            "fax_number": "813-282-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044710",
            "telephone_number": "904-388-0704",
            "fax_number": "904-387-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME28633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372361500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pharmakon LLC (Duval Pharmacy LTC)
• Pharmd for Thee LLC
• La Quenda Mosby Pharr
• Helen Louise Elizabeth Phelan
• Paula R. Phelan, A.P.R.N., C.N.M.
• Juliette Ristaline Phelps Maxwell I, M.D.
• Angela Phelps
• Benjamin Matthew Phelps, MD
• Diana Marie Phelps, MD
• Jordan Micah Phelps, DO

• Obstetrics & Gynecology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.