STEPHEN BLACKSTONE EDSTROM M.D.
NPI 1396942264
Psychiatry & Neurology - Psychiatry in Jbsa Lackland, TX

Q: What is Stephen Edstrom's NPI number?

The NPI number for Stephen Edstrom is 1396942264. It was assigned to this individual provider in the NPPES registry on July 2, 2007.

Q: What is Stephen Edstrom's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Stephen Edstrom was last updated on June 6, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 02, 2007PECOS Enrolled

1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236(210) 292-6255(210) 292-7934 Get Directions Write a Review

NPPES record last updated: June 6, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 6, 2025, Mar 1, 2023, Mar 23, 2018 (3 updates tracked since 2018).

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About Stephen Blackstone Edstrom M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STEPHEN BLACKSTONE EDSTROM M.D. (NPI 1396942264) is an individual psychiatry provider in Jbsa Lackland, Texas, licensed in Ohio (35.151601) and active in the NPI registry since July 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1396942264

Entity TypeIndividualMale

Primary Taxonomy2084P0800X

Provider Legal NameSTEPHEN BLACKSTONE EDSTROMCredential: M.D.

Location Address1100 WILFORD HALL LOOP BLDG 4554Jbsa Lackland, TX 78236-5638

Mailing Address4481 Sugar Maple DrWright Patterson Afb, OH 45433-5536 · (937) 257-0837

Phone(210) 292-6255

Fax(210) 292-7934

Sole ProprietorNo

Enumeration DateJuly 2, 2007

Last NPPES UpdateJune 6, 20253 updates tracked since enumeration

NPPES CertifiedJune 6, 2025

✔ NPI 1396942264 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in OH · 35.151601

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Also ListedFamily MedicineTaxonomy 207Q00000X · License 01066091A (IN)

1100 WILFORD HALL LOOP BLDG 4554, Jbsa Lackland, TX 78236

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stephen Blackstone Edstrom M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78236 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$166.88 typical visit price

range $54.84 – $166.88

Typical copayment $41.72 (range $13.71 – $41.72)

Most-billed visit code 99205

Established Patient

$68.55 typical visit price

range $17.52 – $136.11

Typical copayment $17.13 (range $4.38 – $34.02)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.