NPIMap

Individual provider Active NPI

Brandon Phelps

  • Family Medicine Physician
  • Sheboygan, WI
National Provider Identifier
1902224116
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
64978-21 Issued in WI
Practice address
1813 Ashland Ave
Sheboygan, WI 53081-6125
Phone
(920) 458-4010
NPI assigned
Apr 3, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 64978-21 WI Primary

Addresses

Primary practice location

1813 Ashland Ave
Sheboygan, WI 53081-6125

Mailing address

1813 Ashland Ave
Sheboygan, WI 53081-6125
Phone (920) 458-4010

Other practice location 1

2801 W Kinnickinnic River Pkwy Ste 250
Milwaukee, WI 53215-3678
Phone (414) 649-6732

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20200918002142 IA Practitioner - Family Practice 4880810548 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Rehabilitation Associates LLCGroup PAC ID 2961443072, 275 clinicians
Marengo Memorial HospitalGroup PAC ID 0749199446, 37 clinicians

Practice addresses (Care Compare)

1130 S Scott Blvd
Iowa City, IA 52240-2909
Phone (319) 354-2429

300 W May St
Marengo, IA 52301-1261
Phone 31964255438068

402 S Walnut St
North English, IA 52316-9559
Phone (319) 664-3391

498 N Highland St
Williamsburg, IA 52361-9695
Phone 31964255438068

728 47TH Ave
Amana, IA 52203-8031
Phone (319) 225-8700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64978-21WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marengo Memorial Hospital Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
Marengo Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Marengo Memorial Hospital CurrentSince Oct 1, 2022 Accepting new patients
English Valley Nursing Care Center Inc PastSince Oct 27, 2022 Accepting new patients
Marengo Memorial Hospital Family Medicine Past Accepting new patients

Locations

728 47th Ave
Amana, IA 52203
Phone (319) 225-8700

300 W May St
Marengo, IA 52301
Phone (319) 462-8011

300 W May St
Ste A
Marengo, IA 52301
Phone (319) 642-5543

402 S Walnut St
North English, IA 52316
Phone (319) 664-3211

498 N Highland St
Williamsburg, IA 52361
Phone (319) 642-8068

Interoperability endpoints

  • Direct secure messaging: bphelps749486@direct.unitypoint.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Highland Ridge Care CenterWilliamsburg, IA, CCN 165566 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Apr 2, 2025
English Valley Nursing Care CenterNorth English, IA, CCN 165456 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 27, 2022
Dec 5, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 6

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": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1902224116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 ASHLAND AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530816125",
            "telephone_number": "920-458-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 ASHLAND AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530816125",
            "telephone_number": "920-458-4010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 W Kinnickinnic River Pkwy Ste 250",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153678",
            "country_code": "US",
            "telephone_number": "414-649-6732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "BRANDON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "64978-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.