Individual provider Active NPI

Thomas Michael Hageman, DNP, PMHNP-BC, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Alamo Heights, TX
National Provider Identifier
1780290106
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1042169 Issued in TX
Practice address
430 W Sunset Rd Ste 400
Alamo Heights, TX 78209-1772
Phone
(210) 858-9078
NPI assigned
Sep 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 1042169 TX
Psychiatric/Mental Health Registered Nurse 163WP0808X RN704633 PA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1042169 TX Primary

Addresses

Primary practice location

430 W Sunset Rd Ste 400
Alamo Heights, TX 78209-1772

Mailing address

333 W Cevallos Apt 1115
San Antonio, TX 78204-1222
Phone (609) 651-0091

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220317002867 TX Practitioner - Nurse Practitioner 0941695571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Progressive Behavioral Health, PLLCGroup PAC ID 4486794906, 366 clinicians

Practice addresses (Care Compare)

23051 Kingwood Place Dr
Suite 110
Kingwood, TX 77339-3962
Phone (844) 824-8775

430 W Sunset Rd
Suite 400
San Antonio, TX 78209-1772
Phone (844) 824-8775

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN704633PAMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Behavioral Health, PLLC Psychiatric/Mental Health CurrentSince Mar 14, 2022 Accepting new patients

Locations

308 S Friendswood Dr
Ste 110
Friendswood, TX 77546
Phone (281) 317-0094

12505 Memorial Dr
Ste 230
Houston, TX 77024
Phone (210) 858-9078

23051 Kingwood Place Dr
Ste 110
Kingwood, TX 77339
Phone (281) 374-4500

4242 Medical Dr
Ste 6300
San Antonio, TX 78229
Phone (210) 614-8400

430 W Sunset Rd
Ste 400
San Antonio, TX 78209
Phone (210) 858-9078

Interoperability endpoints

  • Direct secure messaging: pbh.thomashageman@136732.advancedmd-direct.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1780290106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W CEVALLOS APT 1115",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782041222",
            "telephone_number": "609-651-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W SUNSET RD STE 400",
            "city": "ALAMO HEIGHTS",
            "state": "TX",
            "postal_code": "782091772",
            "telephone_number": "210-858-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEMAN",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "credential": "DNP, PMHNP-BC, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1042169",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "PA",
            "license": "RN704633",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1042169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alamo Heights, TX

Sources for this page

Verify at the official NPI Registry.