Kelly C Phelps, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M5808 Issued in ID

Practice address

203 S Daisy St
Salmon, ID 83467-0000

Phone

(208) 756-5600

Fax

(208) 756-4169

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Steele Memorial Medical Center

  • Critical Access Hospital
  • Salmon, ID
  • NPI 1851403265
  NPD
• Steele Memorial Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Salmon, ID
  • NPI 1992913479
  NPD
• Oakdale Medical Group Inc

  • Emergency Medicine Physician
  • Oakdale, CA
  • NPI 1598862054
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1831270073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834670000",
            "telephone_number": "208-756-5600",
            "fax_number": "208-756-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834670000",
            "telephone_number": "208-756-5600",
            "fax_number": "208-756-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "KELLY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-5808",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M5808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004220800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark S Oliverson, DMD
• Rachel Pearson, LPC
• Kylie Peets
• John Dustin Pena, FNP
• Coleen Baird Phelps, LPC
• Physical Therapy Clinic,Inc.
• Porgy and Petunia Pediatric Therapy
• Lance Wesley Port, PA-C
• Linda J Powell, MD
• Joel Rea, RPH.

• Family Medicine Physician in Salmon, ID
• Providers in Salmon, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.