Dante Goodwin, AGNP
Individual provider Active NPI Adult Health Nurse Practitioner · New Britain, CT
NPI 1104479153 · NPPES record last updated Jul 18, 2019
Key facts
- NPI
- 1104479153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 8293 (CT)
- Practice address
- 55 Grand St
New Britain, CT 06052-2021 - Phone
- (860) 223-3617
- NPI assigned
- Jul 18, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Charter Oak Health Center, Inc
Practice addresses (Care Compare)
21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190822002779 | CT | Practitioner - Nurse Practitioner | 7911235395 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8293 | CT | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charter Oak Health Center, Inc. | Current |
Accepting new patients | |
| Charter Oak Health Center, Inc. | Current |
Accepting new patients | |
| Absolute Outcomes, LLC | Past | Accepting new patients |
Locations
21 Grand St
Hartford, CT 06106
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 8293 | CT | Yes |
Addresses
Primary practice location
55 Grand St
New Britain, CT 06052-2021
Mailing address
1274 E Main St Apt C13
Meriden, CT 06450-4868
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://login.pointclickcare.com/home/userLogin.xhtml | Health Information Exchange (HIE) |
Other providers in New Britain, CT
- Lucinda Marie Gonzales
- Alejandro Rey Gonzalez Barreto
- Janeisa Gonzalez Carrero
- Carlos Gonzalez
- Paul Goodfield
- Keri Goodwin
- April P Gordon
- Tiffany Gore
- Julie A Gorman
- Eric R Gorny
All providers in New Britain, CT · Adult Health Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.