Active NPI
Michael Goldhamer, M.D.
- Gastroenterology Physician
- San Diego, CA
National Provider Identifier
1104880202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- G14025
- Practice address
- 501 Washington St
Suite 508
San Diego, CA 92103-2231 - Phone
- (619) 299-2570
- Fax
- (619) 819-7259
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | G14025 | CA | Primary |
Addresses
Primary practice location
501 Washington St
Suite 508
San Diego, CA 92103-2231
Mailing address
501 Washington St
Suite 508
San Diego, CA 92103-2231
Phone (619) 299-2570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G140250 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14025 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| G14025 | CA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292544000000",
"number": "1104880202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 WASHINGTON ST",
"address_2": "SUITE 508",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032231",
"telephone_number": "619-299-2570",
"fax_number": "619-819-7259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 WASHINGTON ST",
"address_2": "SUITE 508",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032231",
"telephone_number": "619-299-2570",
"fax_number": "619-819-7259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDHAMER",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2010-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CA",
"license": "G14025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G140250",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.