Individual provider Active NPI

Mary E. White

  • Clinical Psychologist
  • San Antonio, TX
National Provider Identifier
1407927122
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
24900 Issued in TX
Practice address
616 W Russell PL
San Antonio, TX 78212-3658
Phone
(800) 257-8715
Fax
(800) 819-1655
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 24900 TX Primary

Addresses

Primary practice location

616 W Russell PL
San Antonio, TX 78212-3658

Mailing address

1810 Justin LN
Austin, TX 78757-2409
Phone (512) 453-4561

Other identifiers 3

IdentifierTypeStateIssuer
86040AOtherTXBLUE CROSS BLUE SHIELD
116109302MedicaidTX
116109303MedicaidTX

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110107000048 TX Practitioner - Clinical Psychologist 0941499818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Oaks Geriatric Services P CGroup PAC ID 9234034075, 45 clinicians

Practice addresses (Care Compare)

7272 Wurzbach Rd
San Antonio, TX 78240-4803
Phone (210) 615-3483

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as group
Quality
83.48
Improvement activities
40
Cost
67.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
24900TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince Apr 21, 2021 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients

Locations

3759 Valley View Rd
Austin, TX 78704
Phone (512) 443-3436

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

Organizations & group practices 2

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1407927122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 JUSTIN LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787572409",
            "telephone_number": "512-453-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W RUSSELL PL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123658",
            "telephone_number": "800-257-8715",
            "fax_number": "800-819-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "MARY",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "24900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "86040A",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116109302",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116109303",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.