Individual provider Active NPI

Samantha Goggin, MD

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1023506367
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A163693 Issued in CA
Practice address
4060 Fairmount Ave
Pediatrics Department
San Diego, CA 92105-1608
Phone
(619) 255-9154
Fax
(619) 795-9847
NPI assigned
Apr 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A163693 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
Pediatrics Department
San Diego, CA 92105-1608

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608

Other identifiers 1

IdentifierTypeStateIssuer
132662OtherAMERICAN BOARD OF PEDIATRICS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20220308001313 CA Practitioner - Pediatric Medicine 3870987803 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A163693CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. CurrentSince Nov 25, 2021 Accepting new patients
La Maestra Family Clinic, Inc. Current Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Nov 25, 2021 Accepting new patients
La Maestra Family Clinic Past Accepting new patients

Locations

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

217 Highland Ave
National City, CA 91950
Phone (619) 280-4213

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

Interoperability endpoints

  • Direct secure messaging: samantha.leegoggin.p1@direct.lamaestra.nextgenshare.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1023506367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "address_2": "PEDIATRICS DEPARTMENT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-255-9154",
            "fax_number": "619-795-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOGGIN",
        "first_name": "SAMANTHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A163693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF PEDIATRICS",
            "identifier": "132662",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.