Organization Active NPI

Graceland Psychiatric and Neuromodulation Center PLLC

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1518548262
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GRACELAND PSYCHIATRIC AND NEUROMODULATION CENTER PLLC
Practice address
2411 NE Loop 410 Ste 114
San Antonio, TX 78217-6600
Phone
(210) 868-5801
Fax
(726) 201-1558
NPI assigned
Apr 15, 2021
Last updated
Jan 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

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

Authorized official

Name
Femi PopoolaNPI 1417307380
Title
Medical Director
Phone
(210) 868-5801

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

2411 NE Loop 410 Ste 114
San Antonio, TX 78217-6600

Mailing address

2411 NE Loop 410 Ste 114
San Antonio, TX 78217-6600
Phone (210) 868-5801

Other practice location 1

2411 NE Loop 410 Ste 112
San Antonio, TX 78217-6600
Phone (210) 868-5801

Other practice location 2

619 N Providence Rd
Columbia, MO 65203-4355
Phone (573) 606-8644

Other practice location 3

33 E BROADWAY Ste 155
Columbia, MO 65203-4209
Phone (210) 868-5801

Other practice location 4

11212 State Highway 151 Ste 120
San Antonio, TX 78251-4498
Phone (210) 868-5801

Other practice location 5

790 Generations Dr Ste 210
New Braunfels, TX 78130-0087
Phone (210) 868-5801

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL info@gracelandpsychiatry.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210920001551 TX Part B Supplier - Clinic/Group Practice 4789081662 Receives reassigned benefits from 20 practitioners
Practice locations: San Antonio, TX; New Braunfels, TX
O20220127002952 MO Part B Supplier - Clinic/Group Practice 4789081662 Receives reassigned benefits from 2 practitioners
Practice locations: Columbia, MO

National Provider Directory

National Provider Directory

Locations

33 E Broadway
Ste 155
Columbia, MO 65203

8668 John Hickman Pkwy
Ste 301
Frisco, TX 75034

790 Generations Dr
Ste 210
New Braunfels, TX 78130
Phone (210) 445-6778

2003 Rogers Rd
Ste 106
San Antonio, TX 78251
Phone (210) 375-5000

2411 NE Loop 410
Ste 114
San Antonio, TX 78217

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1518548262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 NE LOOP 410 STE 114",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782176600",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 NE LOOP 410 STE 114",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782176600",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2411 NE Loop 410 Ste 112",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782176600",
            "country_code": "US",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 N Providence Rd",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652034355",
            "country_code": "US",
            "telephone_number": "573-606-8644",
            "fax_number": "726-201-1558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "33 E BROADWAY Ste 155",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652034209",
            "country_code": "US",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11212 STATE HIGHWAY 151 STE 120",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782514498",
            "country_code": "US",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "790 Generations Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "New Braunfels",
            "state": "TX",
            "postal_code": "781300087",
            "country_code": "US",
            "telephone_number": "210-868-5801",
            "fax_number": "726-201-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACELAND PSYCHIATRIC AND NEUROMODULATION CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-15",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "POPOOLA",
        "authorized_official_first_name": "FEMI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "210-868-5801"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@gracelandpsychiatry.com",
            "affiliation": "N",
            "address_1": "2411 NE Loop 410 Ste 114",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782176600",
            "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 Jan 14, 2026; 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.