Carolyn M Phelps, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD150022 Issued in OR

Practice address

1112 NE 21St Ave
Suite 6
Portland, OR 97232-2595

Phone

(503) 335-1113

Fax

(503) 334-4333

NPI assigned

Jun 20, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 6, 2017 through Nov 6, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1639374432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 NE 21ST AVE",
            "address_2": "SUITE 6",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322595",
            "telephone_number": "503-335-1113",
            "fax_number": "503-334-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 NE 21ST AVE",
            "address_2": "SUITE 6",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322595",
            "telephone_number": "503-335-1113",
            "fax_number": "503-334-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "CAROLYN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD150022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Ann Phelan, RD,CSR,LD
• Pamela J Phelan, PAC
• Erika Susan Phelps Nishiguchi, MD
• Alicia Aileen Phelps, LCSW
• Andrew Phelps
• Jasmine Phelps, LMT
• Mackenzie Phelps
• Michael Phelps
• Michael Sean Phelps, CPHT
• Randi Ann Phelps, PHD

• Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.