Active NPI
John Anthony Blue Star
- Health Psychologist
- Lackland Afb, TX
National Provider Identifier
1750708863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 593
- Practice address
- 1100 Wilford Hall Loop
Lackland Afb, TX 78236-5638 - Phone
- (210) 292-7361
- NPI assigned
- Mar 26, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | 593 | WY | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop
Lackland Afb, TX 78236-5638
Mailing address
1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Phone (210) 292-7361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 593 | WY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599955200000",
"number": "1750708863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-292-7361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "LACKLAND AFB",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-292-7361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE STAR",
"first_name": "JOHN",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-26",
"last_updated": "2020-09-13",
"certification_date": "2020-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "WY",
"license": "593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.