Individual provider Active NPI

Elizabeth Alexandra Goodman, PA-C

  • Physician Assistant
  • Hartford, CT
National Provider Identifier
1144453374
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002315 Issued in CT
Practice address
80 Seymour Street
Hartford Hospital Orthopedic Dept
Hartford, CT 06102-5037
Phone
(860) 545-2245
NPI assigned
Sep 4, 2009
Last updated
Apr 12, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002315 CT Primary

Addresses

Primary practice location

80 Seymour Street
Hartford Hospital Orthopedic Dept
Hartford, CT 06102-5037

Mailing address

P.O. Box 415933
Hartford Hospital Professional Services
Boston, MA 02241-5933
Phone (860) 545-7602

Other identifiers 1

IdentifierTypeStateIssuer
003023157MedicaidCT

Other names 1

  • Elizabeth A. Nole Former name

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2315CTMDPhysical Therapy Assistant
002315CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Raphael Healthcare System Affiliated Physicians Inc Past Accepting new patients
Saint Raphael Faculty Physicians II Past Accepting new patients
Saint Raphael Faculty Physicians Physician Assistant Past Accepting new patients

Organizations & group practices 3

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": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1144453374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 415933",
            "address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415933",
            "telephone_number": "860-545-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR STREET",
            "address_2": "HARTFORD HOSPITAL ORTHOPEDIC DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025037",
            "telephone_number": "860-545-2245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "ELIZABETH",
        "middle_name": "ALEXANDRA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-04",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003023157",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "NOLE",
            "middle_name": "A.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.