MEDICARE: DR. JERRY L. OESTMANN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	396	NE
2	103T00000X	Psychologist	620	NE
3	101YP2500X	Professional Counselor	188	NE
4	103T00000X	Psychologist	PY9026	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	098935	OTHER	NE	MEDICARE FSI PTAN GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	68505B002	OTHER	NE	TRICARE
4	345680000	OTHER	NE	MAGELLAN MIS ADOL GT
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	80023	OTHER	NE	BLUE CROSS & BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	81118	OTHER	NE	BCBS INDIVIDUAL PROVIDER NUMBER
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	250307	OTHER	NE	MIDLANDS INS
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	345680000	OTHER	NE	MAGELLAN MIS GT SITE
15	349507000	OTHER	NE	MAGELLAN MIS WOMEN'S GT
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	85731	OTHER	NE	BCBS
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790858959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY L. OESTMANN PH.D.

Provider Business Mailing Address
First Line	:	1730 DUNLAWTON AVE
Second Line	:	SUITE 3
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-8985
Country	:	US
Telephone Number	:	386-957-3905
Fax Number	:	386-402-8992

Provider Business Practice Location Address
First Line	:	136 JULIA ST UNIT 100
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7713
Country	:	US
Telephone Number	:	386-423-9162
Fax Number	:	386-423-3094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	10/17/2025