NPIMap

Individual provider Active NPI

Gary S Goldberg, MD

  • Urology Physician
  • Mankato, MN
National Provider Identifier
1013995034
Registry record updated Jul 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
43508 Issued in MN
Practice address
1421 Premiere Dr
Mankato Clinic@ Wickersham Campus
Mankato, MN 56001-6076
Phone
(507) 625-1811
NPI assigned
Jan 9, 2006
Last updated
Jul 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 43508 MN Primary

Addresses

Primary practice location

1421 Premiere Dr
Mankato Clinic@ Wickersham Campus
Mankato, MN 56001-6076

Mailing address

PO Box 8674
1230 E Main St Mankato Clinic LTD
Mankato, MN 56002-8674

Other identifiers 9

IdentifierTypeStateIssuer
392183200MedicaidMN
HP34028OtherMNHEALTH PARTNERS
0568394OtherIAMEDICAID
NA2951028013OtherMNPREFFERED ONE
140754OtherMNUCARE
1808800OtherMNAMERICAS PPO
1900310OtherMNMEDICA
340019399OtherRR MEDICARE
47D36GOOtherMNBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address garygoldberg@mklt.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100106000482 MN Practitioner - Urology 1355421009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
George Washington University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mankato Clinic LTDGroup PAC ID 5597677955, 243 clinicians

Practice addresses (Care Compare)

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 389-8509

1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811

1411 Premier Dr
Mankato, MN 56001-6076
Phone (507) 388-6000

1421 Premier Dr
Mankato, MN 56001-6076
Phone (507) 385-4000

1431 Premier Dr
Mankato, MN 56001-6076
Phone (507) 386-6750

1431 Premier Dr MRI Dept
Orthopaedic and Fracture Clinic
Mankato, MN 56001-6076
Phone (507) 386-6750

1575 Hoover Dr
North Mankato, MN 56003-2667
Phone (507) 387-2037

1575 Lookout Dr
North Mankato, MN 56003-2503
Phone (507) 625-5027

1900 Sunrise Dr
Saint Peter, MN 56082-5376
Phone (507) 931-2200

1901 Old Minnesota Ave
Saint Peter, MN 56082-1763
Phone (504) 934-2325

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43508MNMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Urology CurrentSince Aug 1, 2001 Accepting new patients

Locations

1421 Premier Dr
Mankato, MN 56001
Phone (507) 385-4000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594339200000",
    "number": "1013995034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8674",
            "address_2": "1230 E MAIN ST MANKATO CLINIC LTD",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560028674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 PREMIERE DR",
            "address_2": "MANKATO CLINIC@ WICKERSHAM CAMPUS",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016076",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "GARY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-09",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "43508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "392183200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP34028",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0568394",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFFERED ONE",
            "identifier": "NA2951028013",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "140754",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAS PPO",
            "identifier": "1808800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1900310",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "340019399",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47D36GO",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "garygoldberg@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1421 Premiere Dr",
            "address_2": "Mankato Clinic@ Wickersham Campus",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560016076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.