Amanda Marie Gough, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704311131 Issued in MI

Practice address

43184 Dequindre Rd
Sterling Heights, MI 48314-1709

Phone

(586) 580-0280

NPI assigned

Dec 26, 2018

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 MI

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

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agough595852@direct.hfhs.org
• Direct secure messaging: amandagough@fmcmi.allscriptsdirect.net

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.

• Forum Medical Clinic, PC

  • Internal Medicine Physician
  • Sterling Heights, MI
  • NPI 1992734578
  Medicare reassignment NPD

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

{
    "created_epoch": "1545782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545782400000",
    "number": "1316419609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141709",
            "telephone_number": "586-580-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-26",
        "last_updated": "2018-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704311131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack William Goss, DC
• Mackenzie Kate Goss
• William Francis Goss, DC
• Elyse Gossett
• Dharmendrakumar Radhelalji Goswami, PTA
• Dushaun Goulbourne
• Neethi Venkatappa Gowda, MD
• Nicholas Goza, DDS
• Carolyn Ann Grabiel, NP
• Grace Healing Chiropractic

• Family Nurse Practitioner in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2018; 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.