Active NPI
Charles Michael Goddard II, MD
- Pediatrics Physician
- Dublin, OH
National Provider Identifier
1154483089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 069707
- Practice address
- 7275 Sawmill Road
Northwest Pediatrics, Inc.
Dublin, OH 43016 - Phone
- (614) 766-6321
- Fax
- (614) 766-0193
- NPI assigned
- Dec 15, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 059637 | MI | |
| Pediatrics Physician | 208000000X | 069707 | OH | Primary |
Addresses
Primary practice location
7275 Sawmill Road
Northwest Pediatrics, Inc.
Dublin, OH 43016
Mailing address
7275 Sawmill Road
Northwest Pediatrics, Inc.
Dublin, OH 43016
Phone (614) 766-6321
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11293017 | Other | MI | CAQH PROVIDER ID |
| 328339 | Medicaid | MI | |
| 69707 | Other | OH | OH LICENSE |
| 059637 | Other | MI | MI LICENSE |
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 |
|---|---|---|---|
| 059637 | MI | MD | Pediatrics Physician |
| 069707 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | 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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1154483089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7275 SAWMILL ROAD",
"address_2": "NORTHWEST PEDIATRICS, INC.",
"city": "DUBLIN",
"state": "OH",
"postal_code": "43016",
"telephone_number": "614-766-6321",
"fax_number": "614-766-0193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7275 SAWMILL ROAD",
"address_2": "NORTHWEST PEDIATRICS, INC.",
"city": "DUBLIN",
"state": "OH",
"postal_code": "43016",
"telephone_number": "614-766-6321",
"fax_number": "614-766-0193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODDARD",
"first_name": "CHARLES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "059637",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "069707",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11293017",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "328339",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OH LICENSE",
"identifier": "69707",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MI LICENSE",
"identifier": "059637",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dublin, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.