Robert C Axelrod, MD

Key facts

NPI

1285628099

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatry Physician 2084P0800X

License

MD00042630 (WA)

Practice address

600 Broadway St
Longview, WA 98632-3256

Phone

(360) 414-2236

Fax

(360) 414-2788

NPI assigned

Sep 7, 2005

Sex

Male

Sole proprietor

No

Organizations & group practices 5

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.

• Peacehealth Multi-Specialty Clinic/Center · Longview, WA · NPI 1720056187
  Medicare reassignment Care Compare group NPD WA
• Peacehealth General Acute Care Hospital · Longview, WA · NPI 1073510277
  Care Compare group NPD (past)
• Peacehealth Prosthetic/Orthotic Supplier · Longview, WA · NPI 1184106437
  Care Compare group
• Peacehealth Urology Physician · Longview, WA · NPI 1255977591
  Care Compare group
• Peacehealth Durable Medical Equipment & Medical Supplies · Longview, WA · NPI 1801909171
  Care Compare group

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Peacehealth General Acute Care Hospital · Longview, WA · NPI 1073510277
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Psychiatry
Also: Neurology

Education

Baylor College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Peacehealth (188 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St John Medical Center Hospital · Longview, WA · CCN 500041

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: raxelrod9834@direct.peacehealth.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1285628099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986327154",
            "telephone_number": "360-414-2048",
            "fax_number": "360-575-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323256",
            "telephone_number": "360-414-2236",
            "fax_number": "360-414-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXELROD",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00042630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227372",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8370652",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00071313",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & IND",
            "identifier": "0174698",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8933608",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Longview, WA · Psychiatry Physician in Washington