Individual provider Active NPI

Sue A Moler, PSYD

  • Clinical Psychologist
  • Arizona City, AZ
National Provider Identifier
1265000384
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY-005408 Issued in AZ
Practice address
14574 S Sunland Gin Rd
Arizona City, AZ 85123
Phone
(520) 387-5651
NPI assigned
Jun 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY-005408 AZ Primary

Addresses

Primary practice location

14574 S Sunland Gin Rd
Arizona City, AZ 85123

Mailing address

410 N Malacate St
Ajo, AZ 85321-2254
Phone (559) 250-3541

Other practice location 1

1600 W Chandler Blvd
Chandler, AZ 85224-6153
Phone (480) 524-0990

Other practice location 2

410 N Malacate St
Ajo, AZ 85321-2253
Phone (203) 875-6515

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Chandler Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230823002245 AZ Practitioner - Clinical Psychologist 0840653929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14574 S Sunland Gin Rd
Arizona City, AZ 85123-8448
Phone 52046657743007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
PSY-005408AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Senita Community Health Center CurrentSince May 1, 2024 Accepting new patients
Desert Senita Community Health Center CurrentSince May 1, 2024 Accepting new patients
Child Crisis Arizona PastSince Jun 1, 2021 Accepting new patients
Psychology Specialists LTD Clinical PastSince Jan 29, 2023 Accepting new patients

Locations

410 N Malacate St
Ajo, AZ 85321
Phone (520) 387-5651

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1265000384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "559-250-3541",
            "fax_number": "520-387-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14574 S SUNLAND GIN RD",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "85123",
            "telephone_number": "520-387-5651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W Chandler Blvd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852246153",
            "country_code": "US",
            "telephone_number": "480-524-0990",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "410 N Malacate St",
            "address_purpose": "LOCATION",
            "city": "Ajo",
            "state": "AZ",
            "postal_code": "853212253",
            "country_code": "US",
            "telephone_number": "203-875-6515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLER",
        "first_name": "SUE",
        "middle_name": "A",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "PSY-005408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Chandler",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1600 W Chandler Blvd",
            "city": "Chandler",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852246153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Arizona City, AZ

Sources for this page

Verify at the official NPI Registry.