Charles Michael Goedecke, LSA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

16100 SH 288
Pearland, TX 77584

Phone

(210) 445-9456

NPI assigned

Oct 10, 2016

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1306396759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 HAYLOFT LN",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782451456",
            "telephone_number": "210-445-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16100 SH 288",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "77584",
            "telephone_number": "210-445-9456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5410 WEST LOOP SOUTH",
            "address_2": "MEMORIAL HERMANN ORTHOPEDIC AND SPINE HOSPITAL",
            "address_purpose": "LOCATION",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "77401",
            "country_code": "US",
            "telephone_number": "210-445-9456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOEDECKE",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-10",
        "last_updated": "2021-10-08",
        "certification_date": "2021-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amani Glore
• Alexis Zolan Glover, CPNP-PC
• Marty Glover
• Godontics
• Adreen Godwin, RPH
• Haley Goertz, PT, DPT
• Angelica Goff
• Lynette M Gogol, D.O.
• Sarah Ann Goit, OTR
• Catherine Emily Goldblatt

• Surgical Physician Assistant in Pearland, TX
• Providers in Pearland, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.