Phoenix Center Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD8985 Issued in HI

Legal business name

PHOENIX CENTER INC

Practice address

169 Puueo St
Hilo, HI 96720-2432

Phone

(808) 934-7355

Fax

(808) 935-3209

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Shelley E. Ham, M.D.NPI 1285718411

Title

President

Phone

(808) 934-7355

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Tax ID family

Phoenix Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Phoenix Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hilo, HI
  • NPI 1710986351
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelley Ham, M.D.

  • Psychiatry Physician
  • Hilo, HI
  • NPI 1285718411
  Medicare reassignment Authorized official
• Michael Ham, MSW

  • Clinical Social Worker
  • Lawrenceville, GA
  • NPI 1154405389
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1699849422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10840",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967215840",
            "telephone_number": "808-934-7355",
            "fax_number": "808-935-3209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 PUUEO ST",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967202432",
            "telephone_number": "808-934-7355",
            "fax_number": "808-935-3209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2023-12-12",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-934-7355",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW3200",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "MD8985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lily Pham, RPH
• Tuan Pham, D.D.S.
• Phylavanh Phanhtharath, ACNS-BC
• Pharmacy Corporation of America
• Fatima C Phillips, M.D., M.P.H., PH.D.
• Phoenix Center Inc
• Alicia Iwalani Pi
• Sandra Pickard, L.C.S.W.
• Deborah Piena, LMFT
• Carlota Pieper

• Psychiatry Physician in Hilo, HI
• Providers in Hilo, HI by specialty
• Psychiatry Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.

Verify at the official NPI Registry.