JESSE E PHILLIPS (NPI# 1457351983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457351983 |
| Entity Type | Individual |
| Full Name | JESSE E PHILLIPS |
| Credential | MD |
| Practice Address |
1801 Se Hillmoor Dr Suite B105 Port St Lucie FL 34952-7553 |
| Mailing Address |
1801 Se Hillmoor Dr Suite B105 Port St Lucie FL 34952-7545 |
| Practice Telephone | 7723989911 |
| Practice Fax Number | 7723984374 |
| Mailing Telephone | 7723989911 |
| Mailing Fax Number | 7723984374 |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2015-01-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 01040385A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100462620A | 05 | |
| IN | ANTHEM BCBS | 00000209641 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033763693 | Jesse Phillips Jr. | Behavior Technician | 1050 Fulton Ave Ste 235, Sacramento, CA 95825-4299 | 2019-07-31 |
| 1366930851 | Jesse Lee Phillips Jr. | Behavior Technician | 610 Bercut Dr, Sacramento, CA 95811-0115 | 2018-04-30 |
| 1265788897 | Jesse Sebring Phillips | Physical Therapist | 6801 Park Ter, 2nd Floor, Los Angeles, CA 90045-1543 | 2012-08-01 |
| Street Address |
1801 SE HILLMOOR DR SUITE B105 |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34952-7553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811994742 | Prithvi Raj Sawh | Pediatrics | 1801 Se Hillmoor Dr, Suite A105, Port St Lucie, FL 34952-7553 | 2005-07-07 |
| 1851814008 | Ashley Medora Le Grange | Counselor | 1801 Se Hillmoor Dr, Port St Lucie, FL 34952-7553 | 2017-07-19 |
| 1972040616 | Marvalee Allison | Nurse Practitioner | 1801 Se Hillmoor Dr, 108, Port St Lucie, FL 34952-7553 | 2017-01-19 |
| 1689127201 | Midway Ultrasound Diagnostic Services | Clinic/Center | 1801 Se Hillmoor Dr, Port St Lucie, FL 34952-7553 | 2016-07-31 |
| 1316490931 | Edward Francis Crooks | Spec/Tech, Cardiovascular | 1801 Se Hillmoor Dr, Suite C-207, Port St Lucie, FL 34952-7553 | 2016-07-31 |
| 1477967834 | Leriche Famius Louis | Nurse Practitioner | 1801 Se Hillmoor Dr, Suite B109, Port St Lucie, FL 34952-7553 | 2014-06-13 |
| 1306274998 | Accredited Medical Providers LLC | Urology | 1801 Se Hillmoor Dr, Suite A-103, Port St Lucie, FL 34952-7553 | 2013-10-17 |
| 1417383803 | Marvin Ishmeal Cohen | Nurse Practitioner | 1801 Se Hillmoor Dr, Suite B-105, Port St Lucie, FL 34952-7553 | 2013-09-18 |
| 1306278494 | Cherryl Williams | Acupuncturist | 1801 Se Hillmoor Dr, Suite 109-b, Port St Lucie, FL 34952-7553 | 2013-07-31 |
| 1962774018 | Allergy Specialists of Palm Beaches | Allergy & Immunology | 1801 Se Hillmoor Dr, C107, Port St Lucie, FL 34952-7553 | 2012-02-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215587068 | Carehere LLC | Family Medicine | Carehere Clinic- St. Lucie Psl, 1680 Se Lyngate Drive, Port St Lucie, FL 34952 | 2019-09-13 |
| 1255998274 | Morningside Alf | Assisted Living Facility | 2233 Se Mroningside Alf, Port Saint Lucie, FL 34952 | 2019-05-24 |
| 1336611870 | Med Braces and Supplies, LLC | Durable Medical Equipment & Medical Supplies | 1484 Se Village Green Dr, Port St Lucie, FL 34952 | 2018-12-21 |
| 1689143794 | The Gift of Recovery, LLC | Counselor | 1801 Sw Hillmoor Drive, Suite C-101, Port St. Lucie, FL 34952 | 2018-11-19 |
| 1457830853 | Cathy L Sonier | Counselor | 357 Brazilian Circle, Port St Lucie, FL 34952 | 2018-08-07 |
| 1548756661 | Blo 7 Diabetes Institute Inc | Nutritionist | 1700 Sw Hillmoor Dr., Suite 305, Port St. Lucie, FL 34952 | 2018-07-02 |
| 1780194464 | Doctor's Choice Medical Center | Clinic/Center | 9164 S Us Highway 1, Port St Lucie, FL 34952 | 2017-10-06 |
| 1801305644 | Thandiwe Daley | Behavior Technician | 1935 Se Hillmoor Drive, Apt#159, Port St Lucie, FL 34952 | 2017-09-25 |
| 1700309408 | Lagrand Evan Andrews | Assistant Behavior Analyst | 265 Se Lenard Rd. Apartment 307, Port St. Lucie, FL 34952 | 2017-07-25 |
| 1578085148 | Lavetta S Ivey | Behavior Technician | 7190 Us Federal Hwy 1, Port Saint Lucie, FL 34952 | 2017-07-14 |
| Find all providers in zip 34952 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790057859 | William Bernard Bass | Otolaryngology | 1801 Se Hillmoor Dr Ste B-105, Port St Lucie, FL 34952-7545 | 2012-02-06 |
| 1396703856 | Daniel J Zaluzec | Otolaryngology | 1801 Se Hillmoor Dr Ste C-110, Port St Lucie, FL 34952-7575 | 2006-05-03 |
| 1538209515 | Kenneth Weiss | Otolaryngology | 10377 S Us Highway 1, Ste 101, Port St Lucie, FL 34952-5630 | 2007-02-07 |
| 1932267663 | John T Lanza | Otolaryngology | 1801 Se Hillmoor Dr, Suite B105, Port St Lucie, FL 34952-7545 | 2006-12-05 |
| 1922066216 | James L. Autin, M.d.,p.a. | Otolaryngology | 10377 S Us Highway 1, Ste 101, Port St Lucie, FL 34952-5630 | 2006-05-03 |
| 1184681330 | Drs Berghash & Lanza Pl | Otolaryngology | 1801 Se Hillmoor Dr, Suite B105, Port St Lucie, FL 34952-7545 | 2006-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447870977 | Shanmugasundaram, Venkatachalam | Otolaryngology | 10131 W Forest Hill Blvd Ste 201, Wellington, FL 33414-6109 | 2020-04-24 |
| 1851910517 | Daniel Oswaldo Manrique | Otolaryngology | 325 Saddle Ridge Dr, Davenport, FL 33896-8176 | 2020-04-13 |
| 1932735768 | Martin Alvin Shugar | Otolaryngology | 3850 Hollywood Blvd Ste 401, Hollywood, FL 33021-6746 | 2020-03-12 |
| 1396219242 | North Broward Hospital Distric T | Otolaryngology | 1801 W Sample Rd Ste 101, Deerfield Beach, FL 33064-1370 | 2019-01-14 |
| 1356811194 | Donald Lee Roberts | Otolaryngology | 4251 Commons Dr W Unit 5211, Destin, FL 32541-8636 | 2018-12-04 |
| 1275022238 | Mary Teresa Garrish | Otolaryngology | 405 Sims Way, Merritt Island, FL 32952-5233 | 2018-05-05 |
| 1437658671 | Baptist Ent Specialists Inc | Otolaryngology | 11236 Baptist Health Dr Ste 330, Jacksonville, FL 32218-2989 | 2018-02-02 |
| 1467970368 | Portela E.n.t., Pa | Otolaryngology | 3100 Sw 62nd Ave Ste 124, Miami, FL 33155-3009 | 2017-08-31 |
| 1427414358 | Rufus Madison Holloway Jr. | Otolaryngology | 1616 Lake Shore Drive, Orlando, FL 32803 | 2016-01-07 |
| 1609253178 | Sumeet Bhanot Md Pa | Otolaryngology | 2038 Bee Ridge Road, Suite A, Sarasota, FL 34239 | 2015-05-04 |
| Find all providers with the same taxonomy | ||||
| City | PORT ST LUCIE |
| Zip Code | 34952 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.