NPIMap

Organization Active NPI

Andala Medical Texas PA

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1386224137
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ANDALA MEDICAL TEXAS PA
Practice address
4600 Lockhill Selma Rd Ste 108
San Antonio, TX 78249-2186
Phone
(210) 862-7246
NPI assigned
Apr 14, 2021
Last updated
Nov 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Authorized official

Name
Jackie Lundin
Title
VP Payer Relations
Phone
(248) 921-4652

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

4600 Lockhill Selma Rd Ste 108
San Antonio, TX 78249-2186

Mailing address

4600 Lockhill Selma Rd Ste 108
San Antonio, TX 78249-2186
Phone (210) 862-7246

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220823003740 TX Part B Supplier - Clinic/Group Practice 7416330436 Receives reassigned benefits from 14 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory
Tax ID family
Kalypso Treatment Centers PLLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1386224137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 LOCKHILL SELMA RD STE 108",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782492186",
            "telephone_number": "210-862-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 LOCKHILL SELMA RD STE 108",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782492186",
            "telephone_number": "210-862-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDALA MEDICAL TEXAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "LUNDIN",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "VP PAYER RELATIONS",
        "authorized_official_telephone_number": "248-921-4652"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Nov 10, 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.