Edmund Cavazos III, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

J5084 Issued in TX

Practice address

4242 Medical Dr Ste 6300
San Antonio, TX 78229-5606

Phone

(210) 614-8400

Fax

(210) 614-8165

NPI assigned

Jul 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Progressive Behavioral Health, PLLC

  dba LifeStance Health

  • Mental Health Counselor
  • Friendswood, TX
  • NPI 1659567238

  Psychiatry

  Medicare reassignment NPD

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1568461986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421020897",
            "telephone_number": "270-783-4070",
            "fax_number": "270-783-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4242 MEDICAL DR STE 6300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295606",
            "telephone_number": "210-614-8400",
            "fax_number": "210-614-8165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4402 Vance Jackson Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782305336",
            "country_code": "US",
            "telephone_number": "210-698-7002",
            "fax_number": "210-698-7835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAVAZOS",
        "first_name": "EDMUND",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "30639",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "J5084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64306392",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Lewallen Cavazos, MD
• Cora Cavazos, SLP-A
• Criselda Cavazos, MS,CCC-SLP
• Diana Mercedes Cavazos, RN, MSN, MHSA, PHD
• Dina Cavazos, MS, CRC, LPC
• Erin K Cavazos, LMT
• Fernanda Cavazos
• Jacob Cavazos
• Javen Valerie Cavazos, MD
• Jorge Miguel Cavazos, M.D.

• Psychiatry Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.