Organization Active NPI

Goodside Health Medical, PLLC

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1033972716
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GOODSIDE HEALTH MEDICAL, PLLC
Practice address
9910 Indian School Rd NE Ste 204
Albuquerque, NM 87112-2971
Phone
(512) 884-5190
NPI assigned
Feb 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Brian White
Title
Ceo
Phone
(817) 244-0101

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Clinic/Center 261Q00000X
Multi-Specialty Clinic/Center 261QM1300X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

9910 Indian School Rd NE Ste 204
Albuquerque, NM 87112-2971

Mailing address

1701 River Run Ste 302
Fort Worth, TX 76107-6547

National Provider Directory

National Provider Directory

Locations (25 of 63)

777 Cleveland Ave SW
Ste 308
Atlanta, GA 30315
Phone (512) 884-5190

209 Fayetteville St
Ste 1C
Raleigh, NC 27601
Phone (512) 884-5190

205 N Chicago St
Alton, TX 78573

1203 W Pioneer Pkwy
Arlington, TX 76013
Phone (682) 867-4611

555 S Major Dr
Beaumont, TX 77707

2610 Main St
Ste 105
Buda, TX 78610

905 E Whitestone Blvd
Ste B
Cedar Park, TX 78613
Phone (512) 690-2377

621 Rough Rider Dr
Center, TX 75935

905 Durango Ave
Chilton, TX 76632
Phone (254) 546-1200

1492 Island Grove Rd
Cleburne, TX 76031

1421 Austin St
Columbus, TX 78934

501 N Main
Covington, TX 76636

11661 Preston Rd
Ste 120
Dallas, TX 75230
Phone (214) 363-7242

2110 Hester Ave
Donna, TX 78537

21261 N FM 219
Dublin, TX 76446

12101 Pellicano Dr
El Paso, TX 79936
Phone (915) 937-3105

401 Bear Creek Dr
Euless, TX 76039
Phone (817) 251-5777

499 State Highway 78 N
Farmersville, TX 75442

1025 E 8th St
Ferris, TX 75125

2401 Concord St
Forney, TX 75126

601 Blue Haze Dr
Fort Worth, TX 76108

10301 Berkshire Lake Blvd
Fort Worth, TX 76131
Phone (817) 698-1500

501 Oakland Blvd
Fort Worth, TX 76103

3000 S Hulen St
Ste 180
Fort Worth, TX 76109
Phone (817) 302-9231

3800 Anglin Dr
Fort Worth, TX 76119

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1033972716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 RIVER RUN STE 302",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9910 INDIAN SCHOOL RD NE STE 204",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871122971",
            "telephone_number": "512-884-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODSIDE HEALTH MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-06-13",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-244-0101"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.