NPIMap

Individual provider Active NPI

Glen K Goodman, MD

  • Ophthalmology Physician
  • Waterbury, CT
National Provider Identifier
1043218159
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
67111 Issued in CT
Practice address
87 Grandview Ave
Waterbury, CT 06708-2514
Phone
(203) 574-2020
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 46944 MA
Ophthalmology Physician 207W00000X 67111 CT Primary

Addresses

Primary practice location

87 Grandview Ave
Waterbury, CT 06708-2514

Mailing address

87 Grandview Ave
Waterbury, CT 06708-2514
Phone (203) 574-2020

Other identifiers 1

IdentifierTypeStateIssuer
0177555MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20241202002275 PA Practitioner - Ophthalmology 1759322175 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Boston University School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.94 of 100Reported as group
Quality
89.64
Promoting interoperability
95
Improvement activities
40
Cost
67.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67111CTMDOphthalmology Physician
46944MAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Dec 16, 2024 Accepting new patients
The Cataract Surgery Center of Milford, Inc. CurrentSince Jul 1, 2009 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Dec 16, 2024 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Dec 16, 2024 Accepting new patients
Geisinger-HM Joint Venture, LLC Current Accepting new patients
Geisinger Clinic Past Accepting new patients
Milford-Franklin Eye Center, LLC Ophthalmology Past Accepting new patients
Glen K. Goodman, P.C. Ophthalmology Past Accepting new patients
Milford-Franklin Eye Center, LLC Past Accepting new patients

Locations

145 West St
Milford, MA 01757
Phone (508) 381-5600

100 N Academy Ave
Danville, PA 17822

16 Woodbine Ln
Danville, PA 17821
Phone (570) 271-6531

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

255 Route 220 Hwy
Muncy, PA 17756
Phone (570) 308-2600

75 Newman Ave
Ste 100
Rumford, RI 02916

Interoperability endpoints

  • Direct secure messaging: ggoodman@refocus.intellechartdirect.net
  • Direct secure messaging: kgoodman619491@direct.geisinger.edu
  • Direct secure messaging: ggoodman@refocus.emadirect.md

Organizations & group practices 10

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.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1043218159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082514",
            "telephone_number": "203-574-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082514",
            "telephone_number": "203-574-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "GLEN",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "46944",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "67111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0177555",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.