Active NPI
David Goodwin, PHD
- Psychologist
- Philadelphia, PA
National Provider Identifier
1265512362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS006256L
- Practice address
- 4200 Monument Road
Philadelphia, PA 19131 - Phone
- (215) 581-9110
- Fax
- (215) 581-3827
- NPI assigned
- Oct 16, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS006256L | PA | Primary |
Addresses
Primary practice location
4200 Monument Road
Philadelphia, PA 19131
Mailing address
115 Merbrook LN
Merion Station, PA 19066-1619
Phone (215) 581-9110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS006256L | PA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Belmont Behavioral Hospital, LLC | Current | Accepting new patients | |
| Belmont Behavioral Hospital, LLC | Current | Accepting new patients | |
| Main Line Affiliates | Psychologist | Past | Accepting new patients |
Locations
4200 Monument Rd
Philadelphia, PA 19131
Phone (215) 456-6611
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Belmont Behavioral Hospital
- Psychiatric Hospital
- Philadelphia, PA
- NPI 1629468137
-
dba Belmont Northeast Outpatient Program
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Philadelphia, PA
- NPI 1346621448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265512362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 MERBROOK LN",
"city": "MERION STATION",
"state": "PA",
"postal_code": "190661619",
"telephone_number": "215-581-9110",
"fax_number": "215-581-3827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 MONUMENT ROAD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19131",
"telephone_number": "215-581-9110",
"fax_number": "215-581-3827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWIN",
"first_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS006256L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.