NPIMap

Individual provider Active NPI

Kyle Dean Phillips, DO

  • Family Medicine Physician
  • Clifton, TX
National Provider Identifier
1831147289
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L0904 Issued in TX
Practice address
201 Posey Ave
Clifton, TX 76634-1200
Phone
(254) 675-8621
Fax
(254) 675-2254
NPI assigned
May 5, 2006
Last updated
Sep 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L0904 TX Primary

Addresses

Primary practice location

201 Posey Ave
Clifton, TX 76634-1200

Mailing address

PO Box 72
Clifton, TX 76634-0072
Phone (254) 675-8621

Other identifiers 1

IdentifierTypeStateIssuer
152416703MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081021000159 TX Practitioner - Family Practice 2163580184 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bosque County Hospital DistrictGroup PAC ID 4587997754, shared by 6 NPIs, 30 clinicians

Practice addresses (Care Compare)

201 Posey Ave
Clifton, TX 76634-1200
Phone (254) 675-8621

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
L0904TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bosque County Hospital District Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Bosque County Hospital District Current Accepting new patients
Bosque County Hospital District Past Accepting new patients

Locations

101 S Avenue T
Clifton, TX 76634
Phone (254) 675-8322

201 S Avenue T
Clifton, TX 76634
Phone (254) 675-4101

202 E Jefferson Ave
Whitney, TX 76692
Phone (254) 694-2221

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1831147289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "766340072",
            "telephone_number": "254-675-8621",
            "fax_number": "254-675-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 POSEY AVE",
            "city": "CLIFTON",
            "state": "TX",
            "postal_code": "766341200",
            "telephone_number": "254-675-8621",
            "fax_number": "254-675-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KYLE",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L0904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152416703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, TX

Sources for this page

Verify at the official NPI Registry.