Individual provider Active NPI

Lauren Pearlman Goldenberg, D.O.

  • Pediatrics Physician
  • Phoenix, AZ
National Provider Identifier
1154655983
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
005673 Issued in AZ
Practice address
2601 E Roosevelt St
Pediatrics Department
Phoenix, AZ 85008-4973
Phone
(602) 344-5404
Fax
(602) 344-5859
NPI assigned
Sep 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 20A 11516 CA
Pediatrics Physician 208000000X R1491 AZ
Pediatrics Physician 208000000X 005673 AZ Primary

Addresses

Primary practice location

2601 E Roosevelt St
Pediatrics Department
Phoenix, AZ 85008-4973

Mailing address

2601 E Roosevelt St
Pediatrics Department
Phoenix, AZ 85008-4973
Phone (602) 344-5404

Other identifiers 1

IdentifierTypeStateIssuer
612419MedicaidAZ

Other names 1

  • Dr. Lauren Nicole Pearlman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20151013002222 CA Practitioner - Pediatric Medicine 1153562434 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
005673AZMDPediatrics Physician
R1491AZMDPediatrics Physician
20A 11516CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 15, 2015 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 15, 2015 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1253923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1154655983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "address_2": "PEDIATRICS DEPARTMENT",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973",
            "telephone_number": "602-344-5404",
            "fax_number": "602-344-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "address_2": "PEDIATRICS DEPARTMENT",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973",
            "telephone_number": "602-344-5404",
            "fax_number": "602-344-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDENBERG",
        "first_name": "LAUREN",
        "middle_name": "PEARLMAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-26",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A 11516",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "R1491",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "005673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "612419",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "PEARLMAN",
            "middle_name": "NICOLE",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.