NPIMap

Individual provider Active NPI

Jacob Dillon Gooden, PA-C

  • Physician Assistant
  • Christiansburg, VA
National Provider Identifier
1023622529
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110007515 Issued in VA
Practice address
2900 Lamb Cir Ste 302
Christiansburg, VA 24073-6341
Phone
(540) 731-2000
NPI assigned
Sep 2, 2020
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X 0110007515 VA Primary

Addresses

Primary practice location

2900 Lamb Cir Ste 302
Christiansburg, VA 24073-6341

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5353

Other practice location 1

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20201030000214 VA Practitioner - Physician Assistant 5597175661 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Washington Healthcare Providers LLCGroup PAC ID 1456629369, 264 clinicians
Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-5610

2900 Lamb Cir
Christiansburg, VA 24073-6344

2900 Lamb CR
Suite 7 700B
Christiansburg, VA 24073-6344
Phone (540) 731-7450

6415 Peters Creek Rd
Roanoke, VA 24019-4021
Phone (703) 562-2110

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Associates of Fredericksburg PTR Current Accepting new patients
Carilion Healthcare Corporation CurrentSince Sep 7, 2024 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Jan 1, 2022 Accepting new patients

Locations

2900 Lamb Cir
Ste 302
Christiansburg, VA 24073
Phone (540) 731-7600

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: jgooden184356@direct.carilionclinic.org
  • Direct secure messaging: jgooden68242@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 6

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1023622529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 LAMB CIR STE 302",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240736341",
            "telephone_number": "540-731-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Sam Perry Blvd",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224014453",
            "country_code": "US",
            "telephone_number": "540-741-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODEN",
        "first_name": "JACOB",
        "middle_name": "DILLON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-02",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Christiansburg, VA

Sources for this page

Verify at the official NPI Registry.