Andrew Maxam, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

02006965A Issued in IN

Practice address

9040 Jackson Ave
Tacoma, WA 98431-0001

Phone

(253) 968-0117

NPI assigned

Feb 14, 2021

Last updated

Nov 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1613260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1821681586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXAM",
        "first_name": "ANDREW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-14",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02006965A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karol Kay Mauss, LMHC
• Maverick DC PLLC
• Stephanie Mavin, DNP, ARNP, CPNP-PC
• Colleen G Mawby, PA-C
• Shamsa Z. Mawjee, M.D.
• Leilani Ann Maxera, LCSW
• Maria Jewel Maxey
• Priscilla Elnora Maxey
• Maxim
• Maxim Healthcare Services

• General Practice Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.