Active NPI
Justin B. McGoldrick, M.D.
- Emergency Medicine Physician
- Jefferson City, TN
National Provider Identifier
1114960101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 35270
- Practice address
- 110 Hospital Dr
Jefferson City, TN 37760-5281 - Phone
- (865) 471-2500
- NPI assigned
- Jun 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 35270 | TN | Primary |
Addresses
Primary practice location
110 Hospital Dr
Jefferson City, TN 37760-5281
Mailing address
PO Box 634706
Cincinnati, OH 45263-0001
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3865961 | Medicaid | TN | |
| 4150060 | Other | TN | BLUE CROSS |
| 4014592 | Other | TN | BLUE CROSS |
| P00189111 | Other | TN | RAILROAD MEDICARE |
| 3865960 | Medicaid | TN |
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 |
|---|---|---|---|
| 35270 | TN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson County Hma, LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Medicare Defined Swing Bed Hospital Unit
- Jefferson City, TN
- NPI 1891776217
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1114960101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 634706",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452630001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 HOSPITAL DR",
"city": "JEFFERSON CITY",
"state": "TN",
"postal_code": "377605281",
"telephone_number": "865-471-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOLDRICK",
"first_name": "JUSTIN",
"middle_name": "B.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TN",
"license": "35270",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3865961",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4150060",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4014592",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00189111",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3865960",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.