NPIMap

Organization Active NPI

Deer Oaks Southeast LLC

  • Clinical Psychologist
  • San Antonio, TX
National Provider Identifier
1619112612
Registry record updated Dec 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
DEER OAKS SOUTHEAST LLC
Practice address
7272 Wurzbach Rd
Suite 601
San Antonio, TX 78240-4801
Phone
(210) 615-8880
Fax
(210) 593-9863
NPI assigned
Dec 5, 2008
Last updated
Dec 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2017

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

Authorized official

Name
Paul A Boskind, PH.D.NPI 1780761544
Title
Ceo/Owner
Phone
(888) 365-6271

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

7272 Wurzbach Rd
Suite 601
San Antonio, TX 78240-4801

Mailing address

7272 Wurzbach Rd
Suite 601
San Antonio, TX 78240-4801
Phone (888) 365-6271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC, DC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20170928000739 VA Part B Supplier - Clinic/Group Practice 7719251875 Receives reassigned benefits from 29 practitioners
Practice locations: Orange, VA; Virginia Beach, VA; Rich Creek, VA; Richmond, VA; Roanoke, VA; Staunton, VA; Waynesboro, VA; Williamsburg, VA…
O20171215001181 NC Part B Supplier - Clinic/Group Practice 7719251875 Receives reassigned benefits from 4 practitioners
Practice locations: Edenton, NC
O20260204003613 DC Part B Supplier - Clinic/Group Practice 7719251875 Receives reassigned benefits from 2 practitioners
Practice locations: Falls Church, VA

National Provider Directory

National Provider Directory

Locations

7272 Wurzbach Rd
Ste 601
San Antonio, TX 78240
Phone (210) 615-3472

2081 Langhorne Rd
Lynchburg, VA 24501
Phone (434) 846-8437

3900 Llewellyn Ave
Ste 601
Norfolk, VA 23504

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513641600000",
    "number": "1619112612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7272 WURZBACH RD",
            "address_2": "SUITE 601",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404801",
            "telephone_number": "888-365-6271",
            "fax_number": "210-593-9863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7272 WURZBACH RD",
            "address_2": "SUITE 601",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782404801",
            "telephone_number": "210-615-8880",
            "fax_number": "210-593-9863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER OAKS SOUTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2017-12-19",
        "status": "A",
        "authorized_official_last_name": "BOSKIND",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "888-365-6271",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "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 Dec 19, 2017; 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.