Active NPI
Theodore George Phillips, MD
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Allentown, PA
National Provider Identifier
1710938725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- License
- MD041580L
- Practice address
- 1250 S Cedar Crest Blvd
Suite 310
Allentown, PA 18103-6224 - Phone
- (610) 402-6890
- Fax
- (610) 402-6892
- NPI assigned
- May 15, 2006
- Last updated
- Nov 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | MD041580L | PA | Primary |
Addresses
Primary practice location
1250 S Cedar Crest Blvd
Suite 310
Allentown, PA 18103-6224
Mailing address
PO Box 783311
Philadelphia, PA 19178-3311
Phone (484) 884-4500
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000637659 | Other | PA | KEYSTONE EAST |
| 50039540 | Other | PA | CAPITAL BLUE CROSS |
| 637659 | Other | PA | HIGHMARK BLUE SHIELD |
| 637659 | Other | PA | KEYSTONE CENTRAL |
| 0012385870005 | Medicaid | PA | |
| 1511814 | Other | PA | GATEWAY HEALTH PLAN |
| 35920 | Other | PA | GEISINGER HEALTH PLAN |
| P00192724 | Other | PA | RAILROAD MEDICARE |
| 0467898000 | Other | PA | AMERIHEALTH (IBC) |
| 20034834 | Other | PA | AMERIHEALTH MERCY |
| 30022212 | Other | PA | KEYSTONE MERCY |
| 3641356 | Other | PA | AETNA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD041580L | PA | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448409600000",
"number": "1710938725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 783311",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191783311",
"telephone_number": "484-884-4500",
"fax_number": "484-884-0699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 S CEDAR CREST BLVD",
"address_2": "SUITE 310",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "181036224",
"telephone_number": "610-402-6890",
"fax_number": "610-402-6892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "THEODORE",
"middle_name": "GEORGE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2015-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "PA",
"license": "MD041580L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE EAST",
"identifier": "000637659",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50039540",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "637659",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE CENTRAL",
"identifier": "637659",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0012385870005",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY HEALTH PLAN",
"identifier": "1511814",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER HEALTH PLAN",
"identifier": "35920",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00192724",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH (IBC)",
"identifier": "0467898000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH MERCY",
"identifier": "20034834",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "30022212",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3641356",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Allentown, PA
- Jillian Phillips, RDN
- Jonathan Phillips
- Julie Phillips, M.D.
- Lisa Mae Phillips, OTR/L
- Maya Tylor Ella Phillips
- Timothy Hyland Phillips, DO
- Phoebe Corporate & Community Based Services (Center for Excellence in Dementia Care)
- Phoebe Home
- Phoebe Home Inc (Phoebe Allentown Health Care Center)
- Phoebe Services Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.