NPIMap

Organization Active NPI

Maldonado Psychiatric Association

  • Specialist
  • San Antonio, TX
National Provider Identifier
1962656199
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K2359 Issued in TX
Legal business name
MALDONADO PSYCHIATRIC ASSOCIATION
Practice address
1634 Lockhill Selma Rd
San Antonio, TX 78213-1929
Phone
(210) 541-8455
NPI assigned
Nov 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

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

Authorized official

Name
Mrs. Tammy Fountain
Title
Office Manager
Phone
(210) 541-8455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X K2359 TX Primary

Addresses

Primary practice location

1634 Lockhill Selma Rd
San Antonio, TX 78213-1929

Mailing address

1634 Lockhill Selma Rd
San Antonio, TX 78213-1929
Phone (210) 541-8455

Other identifiers 1

IdentifierTypeStateIssuer
149418903MedicaidTX

Other names 1

  • Jorge Maldonado Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090518000296 TX Part B Supplier - Clinic/Group Practice 9234288499 Receives reassigned benefits from 8 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

1634 Lockhill Selma Rd
San Antonio, TX 78213
Phone (210) 541-8455

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1962656199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1634 LOCKHILL SELMA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131929",
            "telephone_number": "210-541-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 LOCKHILL SELMA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131929",
            "telephone_number": "210-541-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALDONADO PSYCHIATRIC ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "210-541-8455",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "K2359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149418903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jorge Maldonado",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 21, 2010; 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.