Active NPI
Frederick Mason Phelps, PT
- Physical Therapist
- Lisbon, CT
National Provider Identifier
1841209855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003524
- Practice address
- 2B Lee Rd
Lisbon, CT 06351-3042 - Phone
- (860) 376-2564
- Fax
- (860) 376-4812
- NPI assigned
- Aug 7, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 003524 | CT | Primary |
Addresses
Primary practice location
2B Lee Rd
Lisbon, CT 06351-3042
Mailing address
2B Lee Rd
Lisbon, CT 06351-3042
Phone (860) 376-2564
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080003524CT01 | Other | CT | BCBS |
| 004066973 | Medicaid | CT |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003524 | CT | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Killingly Medical Center LLC | 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.
-
- Family Medicine Physician
- Dayville, CT
- NPI 1609306539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1841209855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2B LEE RD",
"city": "LISBON",
"state": "CT",
"postal_code": "063513042",
"telephone_number": "860-376-2564",
"fax_number": "860-376-4812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2B LEE RD",
"city": "LISBON",
"state": "CT",
"postal_code": "063513042",
"telephone_number": "860-376-2564",
"fax_number": "860-376-4812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "FREDERICK",
"middle_name": "MASON",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-07",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "003524",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "080003524CT01",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004066973",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lisbon, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.