Timothy Edwin Phelan, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

G084901 Issued in CA

Practice address

1621 Creekside Dr
102
Folsom, CA 95630-3493

Phone

(916) 984-7428

NPI assigned

Dec 13, 2006

Last updated

Feb 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Oregon Health Sciences University School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marshall Medical CenterGroup PAC ID 7517875859, shared by 7 NPIs, 168 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital of Folsom Hospital, Folsom, CA, CCN 050414

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tpheland42751@hisp.ehr.sutterhealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Timothy E Phelan, M.D a Professional Medical Corporation

  dba Creekside OB/Gyn of Folsom Medical Corporation

  • Specialist
  • Folsom, CA
  • NPI 1659564730
  Medicare reassignment NPD Authorized official
• Dignity Health

  dba Mercy Hospital of Folsom

  • General Acute Care Hospital
  • Folsom, CA
  • NPI 1356389878
  NPD (past)
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)
• Sutter Regional Medical Foundation

  • Family Medicine Physician
  • Fairfield, CA
  • NPI 1558388504

  Single Specialty

  NPD (past)
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Health

  dba Mercy Hospital of Folsom

  • General Acute Care Hospital
  • Folsom, CA
  • NPI 1356389878
  Care Compare affiliation

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1760543375",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "TIMOTHY",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G084901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA LICENSE NUMBER",
            "identifier": "G084901",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "00G849011",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phaedrus Consulting, LLC (New Planes)
• Hanh Thi Pham, D.D.S.
• Tiffany H Phan, OD, FAAO
• Alicia Cherie Pharis
• Aida S. Phelan, M.D.
• Tracy Phelps
• Julie Ann Huat Phenco, M.D.
• Nayah Phetdara
• Philip J Orisek, M.D. Inc.
• Corrie Deann Phipps, SLPA

• Obstetrics & Gynecology Physician in Folsom, CA
• Providers in Folsom, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.