Active NPI
Michael Goodkin, MD
- Cardiovascular Disease Physician
- Media, PA
National Provider Identifier
1043284656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- MD019064E
- Practice address
- 1088 W Baltimore Pike
Suite 2400
Media, PA 19063-5146 - Phone
- (610) 565-2100
- Fax
- (610) 892-0626
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | MD019064E | PA | Primary |
Addresses
Primary practice location
1088 W Baltimore Pike
Suite 2400
Media, PA 19063-5146
Mailing address
207 N Broad St
3Rd FLR.
Philadelphia, PA 19107-1500
Phone (215) 462-7100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000639124 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD019064E | PA | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313366400000",
"number": "1043284656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 N BROAD ST",
"address_2": "3RD FLR.",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071500",
"telephone_number": "215-462-7100",
"fax_number": "215-463-3820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1088 W BALTIMORE PIKE",
"address_2": "SUITE 2400",
"city": "MEDIA",
"state": "PA",
"postal_code": "190635146",
"telephone_number": "610-565-2100",
"fax_number": "610-892-0626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODKIN",
"first_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2011-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "PA",
"license": "MD019064E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000639124",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Media, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.