Individual provider Active NPI

Paul A. Mostrom

  • Clinical Psychologist
  • El Paso, TX
National Provider Identifier
1336312412
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
011404 Issued in NY
Practice address
5001 N Piedras St
El Paso, TX 79930-4210
Phone
(915) 564-6100
NPI assigned
Apr 9, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging Psychologist 103TA0700X 011404 NY
Cognitive & Behavioral Psychologist 103TB0200X 011404 NY
Clinical Psychologist 103TC0700X 011404 NY Primary
Forensic Psychologist 103TF0200X 011404 NY
Health Psychologist 103TH0004X 011404 NY

Addresses

Primary practice location

5001 N Piedras St
El Paso, TX 79930-4210

Mailing address

5001 N Piedras
El Paso, TX 79930-6400
Phone (915) 564-6100

Other identifiers 1

IdentifierTypeStateIssuer
01605669MedicaidNY

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 Philosophy

State licenses

LicenseStateTypeSpecialty
011404NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1336312412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 N PIEDRAS",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799306400",
            "telephone_number": "915-564-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 N PIEDRAS ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799304210",
            "telephone_number": "915-564-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSTROM",
        "first_name": "PAUL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NY",
            "license": "011404",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "011404",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011404",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NY",
            "license": "011404",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NY",
            "license": "011404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01605669",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.