Jordan Paul Backstrom, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

10520 Issued in MA

Practice address

85 1St Ave
Waltham, MA 02451-1105

Phone

(781) 895-7963

NPI assigned

Apr 20, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cypress Counseling Center PCGroup PAC ID 3971736315, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cypress Counseling Center, P.C.

  • Clinical Psychologist
  • Ann Arbor, MI
  • NPI 1679992432
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1124552708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 1ST AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511105",
            "telephone_number": "781-895-7963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 1ST AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511105",
            "telephone_number": "781-895-7963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKSTROM",
        "first_name": "JORDAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "10520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brendah Ayiyochan
• B-XII Waltham LLC
• Arthur Bababekov, OD
• Jessica Babcock
• Brianna Bach, LMHC
• Backyard SLP, LLC
• Saskia Bagatais
• Hassanatu Bah
• Mary Bailey-Edwards, MSW
• Hannah Baird

• Clinical Psychologist in Waltham, MA
• Providers in Waltham, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.