Organization Active NPI

Axion Medical Group

  • General Practice Physician
  • Chicago, IL
National Provider Identifier
1922671437
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
AXION MEDICAL GROUP
Practice address
7118 S Jeffery Blvd
Chicago, IL 60649-2426
Phone
(702) 460-5799
NPI assigned
Jul 22, 2021
Last updated
Jul 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Allen Fobbs
Title
President
Phone
(702) 460-5799

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Family Psychologist 103TF0000X
Health Service Psychologist 103TH0100X
Marriage & Family Therapist 106H00000X
Public Health & General Preventive Medicine Physician 2083P0901X
General Practice Physician 208D00000X Primary
Primary Care Clinic/Center 261QP2300X
Medical Physician Assistant 363AM0700X
Adult Health Nurse Practitioner 363LA2200X
Community Health Nurse Practitioner 363LC1500X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Primary Care Nurse Practitioner 363LP2300X
Health Psychologist 103TH0004X
Prescribing (Medical) Psychologist 103TP0016X

Addresses

Primary practice location

7118 S Jeffery Blvd
Chicago, IL 60649-2426

Mailing address

10627 Country Knoll Way
Las Vegas, NV 89135-1258
Phone (702) 243-2777

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1922671437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10627 COUNTRY KNOLL WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891351258",
            "telephone_number": "702-243-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7118 S JEFFERY BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606492426",
            "telephone_number": "702-460-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXION MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "FOBBS",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-460-5799"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.