John Ethan Goodrich, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A149423 Issued in CA

Practice address

4610 X St
Sacramento, CA 95817-2200

Phone

(916) 816-0478

NPI assigned

Jan 6, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jgoodrich456714@hisp.ehr.sutterhealth.org

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.

• Valley Children'S Medical Group

  • Pediatrics Physician
  • Modesto, CA
  • NPI 1437555265
  Medicare reassignment NPD

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1124449442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 ROSE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947091430",
            "telephone_number": "424-366-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 X ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172200",
            "telephone_number": "916-816-0478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 Montgomery Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954054801",
            "country_code": "US",
            "telephone_number": "707-525-5300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Pole Line Rd W",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015810",
            "country_code": "US",
            "telephone_number": "208-381-2645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODRICH",
        "first_name": "JOHN",
        "middle_name": "ETHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-06",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A149423",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-17073",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A149423",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore Avram Goodman, MD
• Caitlin Goodmanson
• James Edgar Goodnight Jr., M.D.
• Cynthia Goodnough
• Thomas M. Goodnow, CRNA
• Mary Anne Goodrich
• Susan Jean Goodrich, M.S.
• Jenna Rae Goodson
• Brandon Goodwin
• Kelsey Goodwin

• Pediatrics Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.