Jamie Lynn Goldberg, MD
Individual provider Active NPI Dermatology Physician · Halethorpe, MD
NPI 1265725352 · NPPES record last updated Jun 27, 2021
Key facts
- NPI
- 1265725352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- MD454022 (PA)
- Practice address
- 1701 Twin Springs Rd
Halethorpe, MD 21227-3553 - Phone
- (410) 737-5250
- NPI assigned
- May 23, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- University of Maryland School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Mid Atlantic States, Inc
Practice addresses (Care Compare)
1701 Twin Springs Rd
Halethorpe, MD 21227-3553
Phone (410) 737-5000
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161013002212 | MD | Practitioner - Dermatology | 4880906544 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1-0011295 | DE | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients |
Locations
7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600
7190 Crestwood Blvd
Frederick, MD 21703
Phone (240) 529-1700
1701 Twin Springs Rd
Halethorpe, MD 21227
Phone (410) 737-5000
2101 E Jefferson St
Ste 6
Rockville, MD 20852
2101 E Jefferson St
#4E
Rockville, MD 20852
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | C1-0011295 | DE | |
| Dermatology Physician | 207N00000X | MD454022 | PA | Yes |
Addresses
Primary practice location
1701 Twin Springs Rd
Halethorpe, MD 21227-3553
Mailing address
1701 Twin Springs Rd
Halethorpe, MD 21227-3553
Phone (410) 737-5250
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Other providers in Halethorpe, MD
- Mona Kaur Gahunia
- Jeffrey Gambel
- Genesis Physiatry Consultants LLC
- Jose Joshua Geronimo
- Goffe Health and Wellness LLC
- Hilary Sara Good
- Jesalyn Gordon
- Grace Ambulance Services LLC
- Quiana Marie Green
- Groundwork Behavioral Health Services Corp
All providers in Halethorpe, MD · Dermatology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.