Andrew Goodrum, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA66152 Issued in CA

Practice address

13690 E 14TH St Ste 200
San Leandro, CA 94578-2584

Phone

(510) 297-0550

NPI assigned

Jul 12, 2024

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• East Bay Hand Medical Center, Inc

  • Specialist
  • San Leandro, CA
  • NPI 1003305236
  Medicare reassignment

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

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1245077577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14376",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941140376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13690 E 14TH ST STE 200",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782584",
            "telephone_number": "510-297-0550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 Telegraph Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093239",
            "country_code": "US",
            "telephone_number": "800-607-6377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODRUM",
        "first_name": "ANDREW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-12",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA66152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vidal Salgado Gonzalez
• Jahsaan Markel Goode
• Nathaniel Van Goodlow, PH.D.
• Heather Rose Goodman
• Haley Michaela Goodrich
• Khushbu Aggarwal Gopalakrishnan, DDS
• Marvah Hama Gorlorwulu
• Eowyn Gorman
• Margaret Riccelli Goulder
• Julia Lynne Gourley

• Physician Assistant in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; 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.