NPIMap

Individual provider Active NPI

Ryan Glynn Goodman

  • Medical Physician Assistant
  • Grand Junction, CO
National Provider Identifier
1053860387
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0004792 Issued in CO
Practice address
1060 Orchard Ave
Grand Junction, CO 81501-2997
Phone
(970) 644-3740
NPI assigned
Sep 28, 2016
Last updated
Sep 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.0004792 CO Primary

Addresses

Primary practice location

1060 Orchard Ave
Grand Junction, CO 81501-2997

Mailing address

1060 Orchard Ave
Grand Junction, CO 81501-2997
Phone (970) 644-3740

Other names 1

  • Ryan Goodman Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20170125001110 CO Practitioner - Physician Assistant 3173805249 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Group LLCGroup PAC ID 1052612785, 109 clinicians

Practice addresses (Care Compare)

1060 Orchard Ave
Grand Junction, CO 81501-2997
Phone (970) 644-3740

607 28
Grand Junction, CO 81506-6018
Phone (970) 243-3300

731 Iowa Ave
Suite a
Palisade, CO 81526-8661
Phone (970) 644-4050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0004792COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado West Healthcare System CurrentSince Dec 14, 2016 Accepting new patients
Colorado West Healthcare System CurrentSince Dec 14, 2016 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
St Mary's Hospital and Medical Center, Inc CurrentSince Aug 24, 2024 Accepting new patients
St Mary's Hospital and Medical Center, Inc CurrentSince Aug 24, 2024 Accepting new patients
Community Medical Group, LLC CurrentSince Jul 4, 2017 Accepting new patients
Community Medical Group, LLC CurrentSince Jul 4, 2017 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
Community Medical Group, LLC Past Accepting new patients
Community Medical Group, LLC Past Accepting new patients

Locations

500 Eldorado Blvd
Ste 4300
Broomfield, CO 80021

101 Jurassic Ave
Unit B
Fruita, CO 81521
Phone (970) 858-6677

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

2478 Patterson Rd
Ste 27
Grand Junction, CO 81505
Phone (970) 257-1862

2570 Patterson Rd
Grand Junction, CO 81505
Phone (970) 298-6601

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

731 Iowa Ave
Ste A
Palisade, CO 81526
Phone (970) 644-4050

Interoperability endpoints

  • Direct secure messaging: ryangoodman@gvpc.allscriptsdirect.net

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 1

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": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475020800000",
    "number": "1053860387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 ORCHARD AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012997",
            "telephone_number": "970-644-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 ORCHARD AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012997",
            "telephone_number": "970-644-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "RYAN",
        "middle_name": "GLYNN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RYAN",
            "last_name": "GOODMAN",
            "credential": "P.A.-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.