David Theodore Goudreault, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

3455 Main St Ste 5
Springfield, MA 01107-1142

Phone

(413) 733-9600

Fax

(413) 732-6534

NPI assigned

Jun 21, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New England Dermatology PCGroup PAC ID 9436113677, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baystate Medical Center Hospital, Springfield, MA, CCN 220077
• Cooley Dickinson Hospital Inc,the Hospital, Northampton, MA, CCN 220015

Merit-based Incentive Payment System (MIPS)

Final score

73.06 of 100Reported as group

Quality

64.46

Improvement activities

40

Cost

75.35

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• New England Dermatology, P.C.

  • Dermatology Physician
  • Springfield, MA
  • NPI 1356348098
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baystate Medical Center Inc

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1487655064
  Care Compare affiliation
• Baystate Medical Center Inc

  • Clinical Medical Laboratory
  • Springfield, MA
  • NPI 1568488450

  Hospital

  Care Compare affiliation
• Cooley Dickinson Hospital Inc

  • General Acute Care Hospital
  • Northampton, MA
  • NPI 1477596310
  Care Compare affiliation
• Cooley Dickinson Hospital Inc

  • Psychiatric Hospital Unit
  • Northampton, MA
  • NPI 1871512814
  Care Compare affiliation

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1215668207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 MAIN ST STE 5",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071147",
            "telephone_number": "413-733-9600",
            "fax_number": "413-732-6534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 MAIN ST STE 5",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071142",
            "telephone_number": "413-733-9600",
            "fax_number": "413-732-6534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDREAULT",
        "first_name": "DAVID",
        "middle_name": "THEODORE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-21",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brita LM Gotberg
• Heather E Gotha, MD
• Shruti Shekhar Gothoskar, MD, MPH
• Gunjan Gotra, M.A.
• Amy S Gottlieb, MD
• Robert A Goulart, MD
• Danielle Marie Gould, NP
• Fantasia Gould, LPN
• Celia Gouldbourne-Dunkelly, NP
• Sugam Gouli

• Medical Physician Assistant in Springfield, MA
• Providers in Springfield, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.