Active NPI
Don Alan Axsom, PSY.D.
- Psychologist
- Surprise, AZ
National Provider Identifier
1306892492
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Oct 20, 2022.
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2006006562
- Practice address
- 14780 W. Mountain View Blvd.
Suite 110
Surprise, AZ 85374-7280 - Phone
- (623) 374-7774
- Fax
- (877) 796-5302
- NPI assigned
- May 26, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2006006562 | MO | Primary |
Addresses
Primary practice location
14780 W. Mountain View Blvd.
Suite 110
Surprise, AZ 85374-7280
Mailing address
694 N. Collete Circle
Tucson, AZ 85748
Phone (417) 399-4828
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006006562 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444780800000",
"number": "1306892492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "694 N. COLLETE CIRCLE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85748",
"telephone_number": "417-399-4828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14780 W. MOUNTAIN VIEW BLVD.",
"address_2": "SUITE 110",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853747280",
"telephone_number": "623-374-7774",
"fax_number": "877-796-5302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AXSOM",
"first_name": "DON",
"middle_name": "ALAN",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2015-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "2006006562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.