NPIMap

Individual provider Active NPI

Clive Anthony Goulbourne, MD

  • Cardiovascular Disease Physician
  • Springfield, MO
National Provider Identifier
1083024970
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2022040707 Issued in MO
Practice address
1235 E Cherokee St
Springfield, MO 65804-2203
Phone
(417) 820-3911
NPI assigned
May 1, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 87980 GA
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 2022040707 MO Primary

Addresses

Primary practice location

1235 E Cherokee St
Springfield, MO 65804-2203

Mailing address

1235 E Cherokee St
Springfield, MO 65804-2203
Phone (417) 820-3911

Other practice location 1

450 Clarkson Ave
Box 1262
Brooklyn, NY 11203-2012
Phone (718) 270-8867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20221205001317 MO Practitioner - Cardiovascular Disease (Cardiology) 9032451976 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

448 State Hwy 248
Suite 160
Branson, MO 65616-3725
Phone (417) 213-4696

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059
  • Mercy St Francis Hospital Hospital, Mountain View, MO, CCN 261335
  • Mercy Hospital Joplin Hospital, Joplin, MO, CCN 260001
  • Mercy Hospital Aurora Hospital, Aurora, MO, CCN 261316

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
87980GAMDCardiovascular Disease Physician
2022040707MOMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Dec 12, 2022 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Dec 12, 2022 Accepting new patients
Mercy Clinic Joplin LLC Cardiovascular Disease CurrentSince May 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Dec 12, 2022 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

3817 S Springfield Ave
Ste 180
Bolivar, MO 65613
Phone (417) 820-5750

448 State Highway 248
Ste 160
Branson, MO 65616
Phone (417) 213-4696

100 Mercy Way
Ste 320330
Joplin, MO 64804
Phone (417) 627-9993

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Ste 2D
Springfield, MO 65804

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

Organizations & group practices 5

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1083024970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-3911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Clarkson Ave",
            "address_2": "Box 1262",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112032012",
            "country_code": "US",
            "telephone_number": "718-270-8867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOULBOURNE",
        "first_name": "CLIVE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "87980",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2022040707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.