Mary S Soderstrom, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

J0896 Issued in TX

Practice address

1460 Walnut St
Columbus, TX 78934-2131

Phone

(979) 732-6204

NPI assigned

Aug 31, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Stream Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of Texas Southwestern Medical School at Dallas, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Texana CenterGroup PAC ID 7618963265, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Texana Center

  • Multi-Specialty Clinic/Center
  • Rosenberg, TX
  • NPI 1912954058
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1427160704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 AIRPORT AVE",
            "address_2": "BLDG D",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774715759",
            "telephone_number": "281-239-1369",
            "fax_number": "281-239-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 WALNUT ST",
            "city": "COLUMBUS",
            "state": "TX",
            "postal_code": "789342131",
            "telephone_number": "979-732-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "MARY",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "J0896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "STREAM",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dawn Denise Schultz
• SDS Physical Therapy LP
• Holly Elizabeth Seifert, DC
• Beena Manish Shah, MD
• Clinton Joseph Shelvin Jr.
• Lensey Spradley, FNP-C
• Sweeny Hospital District (Columbus Oaks Healthcare Community)
• Kevin Tang
• TBR Homesllc
• Ruth Electra Terry, B.C.-H.I.S.

• Psychiatry Physician in Columbus, TX
• Providers in Columbus, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.