Individual provider Active NPI

Colleen Patricia Goodroe, PA-C

  • Physician Assistant
  • Rockwall, TX
National Provider Identifier
1083824783
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06266 Issued in TX
Practice address
3142 Horizon Rd
Suite 209
Rockwall, TX 75032-7809
Phone
(972) 771-2222
Fax
(972) 771-3350
NPI assigned
May 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1148 TN
Physician Assistant 363A00000X PA06266 TX Primary

Addresses

Primary practice location

3142 Horizon Rd
Suite 209
Rockwall, TX 75032-7809

Mailing address

7610 Stemmons Fwy
Suite 500
Dallas, TX 75247-4231
Phone (214) 689-5960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091119000463 TX Practitioner - Physician Assistant 7810088515 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1148TNMDOptometrist
PA1148TNMDPhysician Assistant
PA06266TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 20, 2014 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 20, 2014 Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: colleen.goodroe@direct.swmed.us

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1083824783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7610 STEMMONS FWY",
            "address_2": "SUITE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752474231",
            "telephone_number": "214-689-5960",
            "fax_number": "214-689-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 HORIZON RD",
            "address_2": "SUITE 209",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750327809",
            "telephone_number": "972-771-2222",
            "fax_number": "972-771-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODROE",
        "first_name": "COLLEEN",
        "middle_name": "PATRICIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA1148",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

Verify at the official NPI Registry.