Active NPI
Andrea Lynn Graber, ED.D.
- Psychologist
- Flagstaff, AZ
National Provider Identifier
1750402673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- AZ1933
- Practice address
- 3 N Leroux St
Suite 206
Flagstaff, AZ 86001-5539 - Phone
- (928) 779-3404
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | AZ1933 | AZ | Primary |
Addresses
Primary practice location
3 N Leroux St
Suite 206
Flagstaff, AZ 86001-5539
Mailing address
3 N Leroux St
Suite 206
Flagstaff, AZ 86001-5539
Phone (928) 779-3404
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041123000177 | AZ | Practitioner - Clinical Psychologist | 7012972672 | Practice locations: Flagstaff, AZ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3 N Leroux
Suite 206
Flagstaff, AZ 86001-5594
Phone (928) 779-3404
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AZ1933 | AZ | MD | Psychologist |
| 1933 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750402673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 N LEROUX ST",
"address_2": "SUITE 206",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860015539",
"telephone_number": "928-779-3404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 N LEROUX ST",
"address_2": "SUITE 206",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860015539",
"telephone_number": "928-779-3404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRABER",
"first_name": "ANDREA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "AZ1933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.