Stephen Blackstone Edstrom, MD in Jbsa Lackland, TX

Stephen Blackstone Edstrom, MD is a medicare enrolled "Psychiatry & Neurology - Psychiatry" physician in Jbsa Lackland, Texas. His current practice location is 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, Texas. You can reach out to his office (for appointments etc.) via phone at (210) 292-6255.

Stephen Blackstone Edstrom is licensed to practice in Ohio (license number 35.151601) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396942264.

Contact Information

	Stephen Blackstone Edstrom, MD
	1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638
	(210) 292-6255
	(210) 292-7934

Map and Direction

Physician's Profile

Full Name	Stephen Blackstone Edstrom
Gender	Male
Speciality	Psychiatry & Neurology - Psychiatry
Location	1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1396942264
Provider Enumeration Date: 07/02/2007
Last Update Date: 06/06/2025

Medicare PECOS Information:

PECOS PAC ID: 4082909684
Enrollment ID: I20230727003418

Medical Identifiers

Medical identifiers for Stephen Blackstone Edstrom such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1396942264	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	01066091A (Indiana)	Secondary
2084P0800X	Psychiatry & Neurology - Psychiatry	35.151601 (Ohio)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stephen Blackstone Edstrom allows following entities to bill medicare on his behalf.

Entity Name	Mahajan Therapeutics, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1669531810 PECOS PAC ID: 8820236524 Enrollment ID: O20160809001647

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stephen Blackstone Edstrom is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Stephen Blackstone Edstrom, MD 4481 Sugar Maple Dr, Wright Patterson Afb, OH 45433-5536 Ph: (937) 257-0837	Stephen Blackstone Edstrom, MD 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 Ph: (210) 292-6255

Reviews and Comments

Psychiatry & Neurology Doctors in Jbsa Lackland, TX

Michell Alexandre Llerena, Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-997-2060
Dr. Cecil Lynn Roberts Jr., MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-7361
Dr. Rohini Mehta, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-4277
Nikaury Rivera Antongiorgi, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1100 Willford Hall Loop, Bldg 4554, Attn: 59 Mdw/sghc, Jbsa Lackland, TX 78236 Phone: 956-794-3297
Dr. Nathan Charles Hines, DO Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-7361
Dr. Belinda Lee Kelly, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 59 Mdw, 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-7749
Stephen Erlach, MD JD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Attn: 59 Mdw/sghc, Jbsa Lackland, TX 78236 Phone: 210-292-7361

Stephen Blackstone Edstrom, MD - Medicare Psychiatry & Neurology in Jbsa Lackland, TX