NPIMap

Organization Active NPI

Ikare Mood Trauma Recovery Clinic

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1003361635
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
Q4829 Issued in TX
Legal business name
IKARE MOOD TRAUMA RECOVERY CLINIC
Practice address
8401 Datapoint Dr Ste 900
San Antonio, TX 78229-5385
Phone
(210) 301-0125
Fax
(844) 965-9528
NPI assigned
Aug 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Dr. Ravindra Shah, PHARMD
Title
Chief Operating Officer
Phone
(267) 210-8357

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Q4829 TX Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X AP129429 TX

Addresses

Primary practice location

8401 Datapoint Dr Ste 900
San Antonio, TX 78229-5385

Mailing address

8401 Datapoint Dr Ste 900
San Antonio, TX 78229-5385
Phone (210) 301-0125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170111000124 TX Part B Supplier - Clinic/Group Practice 1355622051 Receives reassigned benefits from 7 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

8401 Datapoint Dr
Ste 855
San Antonio, TX 78229
Phone (210) 301-0125

2833 Babcock Rd
Ste 309
San Antonio, TX 78229
Phone (210) 404-6705

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14727/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1471996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1003361635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 DATAPOINT DR STE 900",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295385",
            "telephone_number": "210-301-0125",
            "fax_number": "844-965-9528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 DATAPOINT DR STE 900",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295385",
            "telephone_number": "210-301-0125",
            "fax_number": "844-965-9528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKARE MOOD TRAUMA RECOVERY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-24",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RAVINDRA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "267-210-8357",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q4829",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP129429",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.