Andrea Gough-Goldman, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

MD172073 Issued in OR

Practice address

3580 SE 82ND Ave
Portland, OR 97266-2902

Phone

(971) 339-9240

NPI assigned

Apr 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrea.goughgoldman.p1@direct.grandronde.nextgenshare.com

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.

• Coda, Inc.

  • Substance Abuse Rehabilitation Facility
  • Portland, OR
  • NPI 1437213865
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Family Medicine

  Medicare reassignment NPD
• Coda, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Seaside, OR
  • NPI 1750912184
  NPD
• Confederated Tribes of the Grand Ronde Community of Oregon

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Grand Ronde, OR
  • NPI 1174666358

  Family Medicine

  NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455

  Family Medicine

  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Confederated Tribes of the Grand Ronde Community of Oregon

  • Land Ambulance
  • Grand Ronde, OR
  • NPI 1215606132
  NPD (past)
• University Professional Services

  • Pharmacy
  • Beaverton, OR
  • NPI 1073054714
  NPD (past)
• University Professional Services

  • Pediatrics Physician
  • Medford, OR
  • NPI 1225282122
  NPD (past)

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1013273861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 SE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662902",
            "telephone_number": "719-339-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 SE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662902",
            "telephone_number": "971-339-9240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 NE 102nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972203804",
            "country_code": "US",
            "telephone_number": "503-813-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1030 NE Couch St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972323067",
            "country_code": "US",
            "telephone_number": "503-239-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOUGH-GOLDMAN",
        "first_name": "ANDREA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-05",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OR",
            "license": "MD172073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1700 NE 102nd Ave",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972203804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kemper Gottshall
• Jessica Gotzler, MSW, LCSW
• Kelly Anne Goudreau, CNS
• Nylah Aundranique Goudy, LMT
• Laura Gouge, ND
• Samira Gouhar
• Brian Joel Gould, M.D.
• Claire Hoelscher Gould, M.D.
• Katrina Irene Gould, MSW, LCSW
• Stephanie Gould, BEHAVIORAL ANALYST

• Addiction Medicine (Family Medicine) Physician in Portland, OR
• Providers in Portland, OR by specialty
• Addiction Medicine (Family Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.