Individual provider Active NPI

Thomas David Marx, PHD

  • Clinical Psychologist
  • Greenfield, WI
National Provider Identifier
1790895233
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
594057 Issued in WI
Practice address
4848 S 76TH St
Suite 201
Greenfield, WI 53220-4361
Phone
(414) 325-7741
Fax
(414) 325-7735
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 594057 WI Primary

Addresses

Primary practice location

4848 S 76TH St
Suite 201
Greenfield, WI 53220-4361

Mailing address

4848 S 76TH St
Suite 201
Greenfield, WI 53220-4361
Phone (414) 325-7741

Other identifiers 1

IdentifierTypeStateIssuer
39057300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20041021000227 WI Practitioner - Clinical Psychologist 9638130834 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stress Management and Mental Health ClinicsGroup PAC ID 8426954066, 10 clinicians

Practice addresses (Care Compare)

2514 S 102ND St
Suite 275
West Allis, WI 53227-2151
Phone (414) 329-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
594057WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Stress Management & Mental Health Clinics Inc CurrentSince Oct 2, 2004 Accepting new patients
Thousand Mile Journey LLC Past Accepting new patients
Child & Family Therapeutic Systems S.C. Clinical PastSince Jan 1, 1998 Accepting new patients

Locations

2717 N Grandview Blvd
Ste 303
Waukesha, WI 53188
Phone (262) 544-6486

2514 S 102nd St
Ste 275
West Allis, WI 53227
Phone (414) 329-7000

Organizations & group practices 3

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1790895233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4848 S 76TH ST",
            "address_2": "SUITE 201",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204361",
            "telephone_number": "414-325-7741",
            "fax_number": "414-325-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4848 S 76TH ST",
            "address_2": "SUITE 201",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204361",
            "telephone_number": "414-325-7741",
            "fax_number": "414-325-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARX",
        "first_name": "THOMAS",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "594057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39057300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

Verify at the official NPI Registry.