Jack D Goldstein, M.D.1208

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

RI8073 Issued in RI

Practice address

400 Massasoit Ave
Suite 201
E Providence, RI 02914-2012

Phone

(401) 919-5222

Fax

(401) 919-5227

NPI assigned

May 23, 2005

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

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in RI, MA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• LMB Medical LLC

  • Internal Medicine Physician
  • Pawtucket, RI
  • NPI 1972096923
  NPD (past)
• Southern New England Surgery Center

  • Multi-Specialty Clinic/Center
  • Attleboro, MA
  • NPI 1285707174
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1245233261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MASSASOIT AVE",
            "address_2": "SUITE 201",
            "city": "E PROVIDENCE",
            "state": "RI",
            "postal_code": "029142012",
            "telephone_number": "401-919-5222",
            "fax_number": "401-919-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MASSASOIT AVE",
            "address_2": "SUITE 201",
            "city": "E PROVIDENCE",
            "state": "RI",
            "postal_code": "029142012",
            "telephone_number": "401-919-5222",
            "fax_number": "401-919-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSTEIN",
        "first_name": "JACK",
        "middle_name": "D",
        "credential": "M.D.1208",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "RI",
            "license": "RI8073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH",
            "identifier": "15131",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "2432493",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "779577",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200042974",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2797369003",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0900689",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI BLUE CROSS BLUE SHIELD",
            "identifier": "0000022384",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI BLUE CHIP",
            "identifier": "202113",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9020116",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CA",
            "identifier": "61829",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph F Bradshaw, RPH
• Angela Carr, PA
• Krista Beth Curran, MS/CCC-SLP
• Bethany A Erickson-Caron, RNP
• Laura Jeanne Ferlazzo
• Michelle D Goncalves, DMD
• Miatta Zoe Gray
• Richard G Greco, MD
• Inmed Diagnostic Services of Ri, LLC
• Edward V Lally, MD

• Orthopaedic Surgery Physician in E Providence, RI
• Providers in E Providence, RI by specialty
• Orthopaedic Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; 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.