NPIMap

Organization Active NPI

Southtown Psychiatry PLLC

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1346836681
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SOUTHTOWN PSYCHIATRY PLLC
Practice address
909 NE Loop 410 Ste 600
San Antonio, TX 78209-1309
Phone
(210) 332-2727
Fax
(210) 547-9537
NPI assigned
Dec 20, 2020
Last updated
Nov 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Authorized official

Name
Jason Clay Miller, DONPI 1285746974
Title
Owner
Phone
(210) 460-0070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

909 NE Loop 410 Ste 600
San Antonio, TX 78209-1309

Mailing address

909 NE Loop 410 Ste 600
San Antonio, TX 78209-1309
Phone (210) 460-0070

Other practice location 1

20 Hawthorne Park Ct
Greenville, SC 29615-3194
Phone (864) 288-6775

Other practice location 2

4901 Richard St
Jacksonville, FL 32207-7328
Phone (904) 425-0500

Other practice location 3

10020 E 91st St
Tulsa, OK 74133-5835
Phone (918) 940-8801

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ref@crosstownmh.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, SC, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20240205003727 TX Part B Supplier - Clinic/Group Practice 5698118842 Receives reassigned benefits from 9 practitioners
Practice locations: San Antonio, TX
O20240925000223 SC Part B Supplier - Clinic/Group Practice 5698118842 Receives reassigned benefits from 2 practitioners
Practice locations: Bluffton, SC; Greenville, SC; Hilton Head Island, SC; West Columbia, SC
O20241018000260 FL Part B Supplier - Clinic/Group Practice 5698118842 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1608422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1346836681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 NE LOOP 410 STE 600",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782091309",
            "telephone_number": "210-460-0070",
            "fax_number": "210-547-9537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 NE LOOP 410 STE 600",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782091309",
            "telephone_number": "210-332-2727",
            "fax_number": "210-547-9537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Hawthorne Park Ct",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296153194",
            "country_code": "US",
            "telephone_number": "864-288-6775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4901 Richard St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322077328",
            "country_code": "US",
            "telephone_number": "904-425-0500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10020 E 91st St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741335835",
            "country_code": "US",
            "telephone_number": "918-940-8801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHTOWN PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-20",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "CLAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-460-0070",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ref@crosstownmh.com",
            "affiliation": "N",
            "endpointDescription": "secure business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "909 NE Loop 410 Ste 600",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782091309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 27, 2024; 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.