Elizabeth A. Goedecke, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA05062 Issued in TX

Practice address

2200 Bergquist Dr
Suite 1
Lackland a F B, TX 78236-9907

Phone

(210) 292-3871

NPI assigned

Jan 3, 2007

Sex

Female

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 TX

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.

• San Antonio Assisting Services, LLC

  • Specialist
  • San Antonio, TX
  • NPI 1043469323
  Medicare reassignment

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265589436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 LAMONT AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782093751",
            "telephone_number": "210-273-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BERGQUIST DR",
            "address_2": "SUITE 1",
            "city": "LACKLAND A F B",
            "state": "TX",
            "postal_code": "782369907",
            "telephone_number": "210-292-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEDECKE",
        "first_name": "ELIZABETH",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Alan Fujimoto, M.D.
• David Edgar Garcia, R.PH.
• John Albert Gibbons Jr., DO, MPH
• Jennifer B Gillespie, M.ED.
• Markus Peter Gmehlin, RPH
• Heriberto A Gonzalez, PHD
• Revonda Lynn Grayson, PH.D.
• Patrick Grogan
• Robert Craig Guthrie, D.D.S.
• Kathryn Elaine Hall, ARNP

• Physician Assistant in Lackland a F B, TX
• Providers in Lackland a F B, TX by specialty
• Physician Assistant in Texas

• 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.

Verify at the official NPI Registry.