Active NPI
Timothy E Phelan, M.D a Professional Medical Corporation
- Specialist
- Folsom, CA
National Provider Identifier
1659564730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G084901
- Legal business name
- TIMOTHY E PHELAN, M.D A PROFESSIONAL MEDICAL CORPORATION
- Practice address
- 1621 Creekside Dr
102
Folsom, CA 95630-3493 - Phone
- (916) 984-7428
- Fax
- (916) 984-0157
- NPI assigned
- Aug 22, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Timothy Edwin Phelan, M.D.
- Title
- Doctor
- Phone
- (916) 984-7428
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G084901 | CA | Primary |
Addresses
Primary practice location
1621 Creekside Dr
102
Folsom, CA 95630-3493
Mailing address
1621 Creekside Dr
102
Folsom, CA 95630-3493
Phone (916) 984-7428
Other names 1
- Creekside OB/Gyn of Folsom Medical Corporation
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
1621 Creekside Dr
Ste 102
Folsom, CA 95630
Phone (916) 984-7428
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187740800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1299628800000",
"number": "1659564730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 CREEKSIDE DR",
"address_2": "102",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956303493",
"telephone_number": "916-984-7428",
"fax_number": "916-984-0157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1621 CREEKSIDE DR",
"address_2": "102",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956303493",
"telephone_number": "916-984-7428",
"fax_number": "916-984-0157"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TIMOTHY E PHELAN, M.D A PROFESSIONAL MEDICAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-08-22",
"last_updated": "2011-03-09",
"status": "A",
"authorized_official_last_name": "PHELAN",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "EDWIN",
"authorized_official_title_or_position": "DOCTOR",
"authorized_official_telephone_number": "916-984-7428",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "CA",
"license": "G084901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Creekside OB/Gyn of Folsom Medical Corporation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Folsom, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.