Individual provider Active NPI

Mary Beth Ostrom, M.D.

  • Psychiatry Physician
  • Idaho Falls, ID
National Provider Identifier
1972668531
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
M5589 Issued in ID
Practice address
2280 E 25TH St
Idaho Falls, ID 83404-7542
Phone
(208) 227-2100
NPI assigned
Dec 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X M5589 ID Primary

Addresses

Primary practice location

2280 E 25TH St
Idaho Falls, ID 83404-7542

Mailing address

PO Box 742358
Atlanta, GA 30374-2358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20041027001284 ID Practitioner - Psychiatry 3476515917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Texas Medical School at Houston, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Behavioral Health Services LLCGroup PAC ID 7315184272, 7 clinicians

Practice addresses (Care Compare)

2280 E 25TH St
Eastern Idaho Regional Medical Center
Idaho Falls, ID 83404-7542
Phone (208) 227-2260

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M5589IDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Behavioral Health Services, LLC Psychiatry CurrentSince Mar 1, 2013 Accepting new patients
Eastern Idaho Health Services Inc Past Accepting new patients
Eastern Idaho Health Services Inc Past Accepting new patients

Locations

3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100

2280 E 25th St
Idaho Falls, ID 83404
Phone (208) 227-2100

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1972668531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742358",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 E 25TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047542",
            "telephone_number": "208-227-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSTROM",
        "first_name": "MARY",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M5589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.