NPIMap

Organization Active NPI

Gooden Mobile Pod NC PLLC

  • Podiatrist
  • Fayetteville, NC
National Provider Identifier
1073003752
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
GOODEN MOBILE POD NC PLLC
Practice address
311 McFadyen Dr
Fayetteville, NC 28314
Phone
(502) 244-2441
Fax
(502) 254-4069
NPI assigned
May 17, 2018
Last updated
May 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Tamika GoodenNPI 1487968780
Title
Owner
Phone
(502) 244-2441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

311 McFadyen Dr
Fayetteville, NC 28314

Mailing address

12910 Shelbyville Rd Ste 300
Louisville, KY 40243-2404
Phone (502) 244-2441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180703003175 NC Part B Supplier - Clinic/Group Practice 2769738715 Receives reassigned benefits from 21 practitioners
Practice locations: Fayetteville, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1073003752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12910 SHELBYVILLE RD STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432404",
            "telephone_number": "502-244-2441",
            "fax_number": "502-254-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 MCFADYEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28314",
            "telephone_number": "502-244-2441",
            "fax_number": "502-254-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODEN MOBILE POD NC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "GOODEN",
        "authorized_official_first_name": "TAMIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-244-2441"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.