Greg R. Goodman, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

179027-1205 Issued in UT

Practice address

5323 S. Woodrow Street
#102
Murray, UT 84107

Phone

(801) 713-1010

Fax

(801) 713-0665

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

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

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.

• Mountain Medical Physician Specialists PC

  • Diagnostic Radiology Physician
  • Murray, UT
  • NPI 1720035520
  Medicare reassignment

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1023019346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5444 GREEN ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841235632",
            "telephone_number": "801-284-1702",
            "fax_number": "801-262-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 S. WOODROW STREET",
            "address_2": "#102",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-713-1010",
            "fax_number": "801-713-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "GREG",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "UT",
            "license": "179027-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D0968",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marc Christopher Santos Gonzales, DPM
• Ranae Michelle Gonzales, AGACNP-BC
• Amanda Jae Gonzalez, LCSW
• Cynthia Gonzalez, CSUDC
• Jared Alex Gonzalez, PHARMD
• Lillian H. Goodman, MD
• Samantha Goodrich, MASTERS OF SCIENCE
• Gordon C Jensen Inc
• Benjamin Hollis James Gordon, M.D.
• Michael Charles Gordon, MD

• Vascular Surgery Physician in Murray, UT
• Providers in Murray, UT by specialty
• Vascular Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.