Ray M Rosenbloom, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33167 Issued in TX

Practice address

1114 Lost Creek Blvd Ste 320
Austin, TX 78746

Phone

(512) 983-6816

Fax

(512) 858-2053

NPI assigned

Dec 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Psychologist

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564876800000",
    "number": "1124196985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 DEERFIELD RD",
            "city": "DRIPPING SPRINGS",
            "state": "TX",
            "postal_code": "786204224",
            "telephone_number": "512-983-6816",
            "fax_number": "512-858-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 LOST CREEK BLVD STE 320",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78746",
            "telephone_number": "512-983-6816",
            "fax_number": "512-858-2053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5800 Sussex Dr",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480982359",
            "country_code": "US",
            "telephone_number": "512-983-6816",
            "fax_number": "512-983-6816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSENBLOOM",
        "first_name": "RAY",
        "middle_name": "M",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2019-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301002325",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "33167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11287287",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "620F34837",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steffani Elizabeth Rosenbaum, FNP-C
• Zachary Rosenberg, DC
• Eric Scott Rosenberger, MD
• Howard Max Rosenblatt, M.D.
• Adam Haley Rosenbloom, MD
• Stacey Shannon Rosensteel, SPEECH LANGUAGE PATH
• Leslie Dee Rosenstein, PH.D.
• Karen Michelle Rosenstrauch, CRNA
• Cerece Rosenthal, PSY.D.
• Elise Sylvia Rosenthal, M.A.

• Clinical Psychologist in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.