Leonard J Hedges-Goettl, PSY. D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS009035L Issued in PA

Practice address

1088 W Baltimore Pike
Suite 2205
Media, PA 19063-5146

Phone

(610) 744-2960

Fax

(610) 744-2420

NPI assigned

May 4, 2006

Last updated

Sep 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Leonard J Goettl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aurora Medical Group, Inc.

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  • NPI 1245440601
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1245288067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1088 W BALTIMORE PIKE",
            "address_2": "SUITE 2205",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635146",
            "telephone_number": "610-744-2960",
            "fax_number": "610-744-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 W BALTIMORE PIKE",
            "address_2": "SUITE 2205",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635146",
            "telephone_number": "610-744-2960",
            "fax_number": "610-744-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDGES-GOETTL",
        "first_name": "LEONARD",
        "middle_name": "J",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "263827",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS009035L",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS009035L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "WI1451001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39153700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEONARD",
            "last_name": "GOETTL",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychologist in Media, PA
• Providers in Media, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.