Active NPI
Craig Wallis Tolleson, MD
- Psychiatry Physician
- Flagstaff, AZ
National Provider Identifier
1992719942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 10957
- Practice address
- 2187 N Vickey St
Flagstaff, AZ 86004-6106 - Phone
- (928) 714-6401
- Fax
- (928) 714-6408
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 10957 | MT | Primary |
Addresses
Primary practice location
2187 N Vickey St
Flagstaff, AZ 86004-6106
Mailing address
2187 N Vickey St
Flagstaff, AZ 86004-6106
Phone (928) 714-6401
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 231772 | Other | AZ | AHCCCS |
| 0000092216 | Other | MT | BLUE CROSS/SHIELD OF MONT |
| 36928 | Other | AZ | ARIZONA MEDICAL BOARD |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10957 | MT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Mental Health | Psychiatry | Past | Accepting new patients |
| Vo of Arizona, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Medical Laboratory
- Glendale, AZ
- NPI 1447458682
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Great Falls, MT
- NPI 1144251885
Psychiatry
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1992719942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2187 N VICKEY ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860046106",
"telephone_number": "928-714-6401",
"fax_number": "928-714-6408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2187 N VICKEY ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860046106",
"telephone_number": "928-714-6401",
"fax_number": "928-714-6408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLLESON",
"first_name": "CRAIG",
"middle_name": "WALLIS",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MT",
"license": "10957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "231772",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/SHIELD OF MONT",
"identifier": "0000092216",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARIZONA MEDICAL BOARD",
"identifier": "36928",
"state": "AZ"
}
],
"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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.