Active NPI
Kelly L Phelps, PA-C
- Physician Assistant
- Harrisburg, IL
National Provider Identifier
1700844925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085001033
- Practice address
- 117 E Clark St
Harrisburg, IL 62946-2702 - Phone
- (618) 252-8625
- Fax
- (618) 252-2540
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085001033 | IL | Primary |
Addresses
Primary practice location
117 E Clark St
Harrisburg, IL 62946-2702
Mailing address
PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200
Other practice location 1
7211 US 45 S
Carrier Mills, IL 62917-1305
Phone (618) 994-2321
Other practice location 2
2808 Outer Dr
Marion, IL 62959-5207
Phone (618) 993-3817
Other practice location 3
900 Logan College Road
Carterville, IL 62918
Phone (618) 956-9202
Electronic endpoints 4
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kphelps14086@sih.direct-ci.com | ||
| Direct Messaging Address | kphelps14086@sih.direct-ci.com | ||
| Direct Messaging Address | kphelps14086@sih.direct-ci.com | ||
| Direct Messaging Address | kphelps14086@sih.direct-ci.com |
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
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Century Physicians of Southern Illinois Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Marion, IL
- NPI 1922007533
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613433600000",
"number": "1700844925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3988",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629023988",
"telephone_number": "618-457-5200",
"fax_number": "618-529-0586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 E CLARK ST",
"city": "HARRISBURG",
"state": "IL",
"postal_code": "629462702",
"telephone_number": "618-252-8625",
"fax_number": "618-252-2540"
}
],
"practiceLocations": [
{
"address_1": "7211 US 45 S",
"address_purpose": "LOCATION",
"city": "Carrier Mills",
"state": "IL",
"postal_code": "629171305",
"country_code": "US",
"telephone_number": "618-994-2321",
"fax_number": "618-994-2034",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2808 Outer Dr",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "IL",
"postal_code": "629595207",
"country_code": "US",
"telephone_number": "618-993-3817",
"fax_number": "618-993-3908",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "900 Logan College Road",
"address_purpose": "LOCATION",
"city": "Carterville",
"state": "IL",
"postal_code": "62918",
"country_code": "US",
"telephone_number": "618-956-9202",
"fax_number": "618-956-9205",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHELPS",
"first_name": "KELLY",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2021-02-16",
"certification_date": "2021-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085001033",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kphelps14086@sih.direct-ci.com",
"affiliation": "N",
"address_1": "117 E Clark St",
"city": "Harrisburg",
"state": "IL",
"country_code": "US",
"postal_code": "629462702",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kphelps14086@sih.direct-ci.com",
"affiliation": "N",
"address_1": "900 Logan College Road",
"city": "Carterville",
"state": "IL",
"country_code": "US",
"postal_code": "62918",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kphelps14086@sih.direct-ci.com",
"affiliation": "N",
"address_1": "2808 Outer Dr",
"city": "Marion",
"state": "IL",
"country_code": "US",
"postal_code": "629595207",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kphelps14086@sih.direct-ci.com",
"affiliation": "N",
"address_1": "7211 US 45 S",
"city": "Carrier Mills",
"state": "IL",
"country_code": "US",
"postal_code": "629171305",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Harrisburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.