John Joseph Goedert III, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TC699 Issued in KY

Practice address

1200 Barrett Blvd
Henderson, KY 42420-4950

Phone

(270) 844-8600

Fax

(270) 844-8610

NPI assigned

Jul 7, 2015

Last updated

Apr 23, 2018By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Premise Health of Indiana Medical PC

  dba Industrial Health Services

  • Occupational Medicine Clinic/Center
  • Princeton, IN
  • NPI 1548750466
  NPD (past)

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1295118446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-691-8070",
            "fax_number": "270-691-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BARRETT BLVD",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424204950",
            "telephone_number": "270-844-8600",
            "fax_number": "270-844-8610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 S Tulip Tree Dr",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IN",
            "postal_code": "476702300",
            "country_code": "US",
            "telephone_number": "812-387-2045",
            "fax_number": "812-387-2045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOEDERT",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-07",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001845A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesse B Gillham, DC
• James Bradley Gish, APRN
• Nathan A Gish, APRN
• Vickie Gish, RN
• Robin M Glenn, RN
• Milagros Gonzalez-Yague
• Vandi Gooch, MHA, MSN, APRN-CNP
• Traci Goodman
• Terrye Gower, RPH
• Kendra M Gray, PH.D.

• Physician Assistant in Henderson, KY
• Providers in Henderson, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; 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.