Individual provider Active NPI

Kiefer Gooch, PT, DPT, SCS, MSATC

  • Physical Therapist
  • Dover, DE
National Provider Identifier
1104215177
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
J1-0003263 Issued in DE
Practice address
1695 S State St # a
Dover, DE 19901-5148
Phone
(302) 552-1120
Fax
(302) 552-1121
NPI assigned
Jan 14, 2015
Last updated
Jan 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X J1-0003263 DE Primary

Addresses

Primary practice location

1695 S State St # a
Dover, DE 19901-5148

Mailing address

1695 S State St # a
Dover, DE 19901-5148
Phone (302) 552-1120

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150415000214 DE Practitioner - Physical Therapist in Private Practice 3476871849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Local Solutions LLCGroup PAC ID 8123560778, 6 clinicians

Practice addresses (Care Compare)

1695 S State St
A
Dover, DE 19901-5148
Phone (302) 542-8151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Local Solutions LLC Physical Therapist CurrentSince Sep 24, 2024 Accepting new patients

Locations

1695 S State St
#A
Dover, DE 19901
Phone (302) 542-8151

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1104215177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 S STATE ST # A",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199015148",
            "telephone_number": "302-552-1120",
            "fax_number": "302-552-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 S STATE ST # A",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199015148",
            "telephone_number": "302-552-1120",
            "fax_number": "302-552-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOCH",
        "first_name": "KIEFER",
        "credential": "PT, DPT, SCS, MSATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-14",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J1-0003263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.