Individual provider Active NPI

Clarissa M Chaisson-McRae, M.D.

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1790946986
Registry record updated Sep 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
P6956 Issued in TX
Practice address
4242 Medical Dr Ste 6300
San Antonio, TX 78229-5372
Phone
(844) 824-8775
NPI assigned
Jun 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301092614 MI
Psychiatry Physician 2084P0800X 205287 LA
Psychiatry Physician 2084P0800X P6956 TX Primary

Addresses

Primary practice location

4242 Medical Dr Ste 6300
San Antonio, TX 78229-5372

Mailing address

4242 Medical Dr Ste 6300
San Antonio, TX 78229-5372
Phone (844) 824-8775

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241010002648 TX Practitioner - Psychiatry 9436307493 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2008
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)

4242 Medical Dr
Suite 6300
San Antonio, TX 78229-5372
Phone (844) 824-8775

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
205287LAMDPsychiatry Physician
4301092614MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Behavioral Health, PLLC Psychiatry CurrentSince Sep 27, 2024 Accepting new patients
Our Lady of the Lake Physician Group LLC PastSince Jul 2, 2012 Accepting new patients

Locations

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

Interoperability endpoints

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

Organizations & group practices 2

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": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727481600000",
    "number": "1790946986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4242 MEDICAL DR STE 6300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295372",
            "telephone_number": "844-824-8775"
        },
        {
            "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": "782295372",
            "telephone_number": "844-824-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAISSON-MCRAE",
        "first_name": "CLARISSA",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-19",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301092614",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "205287",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "P6956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.