Individual provider Active NPI

James Clinton Goodwin, DMD

  • Dentist
  • Oro Valley, AZ
National Provider Identifier
1366495087
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
AZ03540 Issued in AZ
Practice address
10134 N Oracle Rd Ste 170
Oro Valley, AZ 85704-7612
Phone
(520) 848-3889
Fax
(520) 989-3134
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X AZ03540 AZ Primary

Addresses

Primary practice location

10134 N Oracle Rd Ste 170
Oro Valley, AZ 85704-7612

Mailing address

10134 N Oracle Rd Ste 170
Oro Valley, AZ 85704-7612
Phone (520) 848-3889

Other practice location 1

8841 E Florentine Rd Ste E
Prescott Valley, AZ 86314-8776
Phone (928) 778-4555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110316000622 AZ Practitioner - Oral Surgery 1850416215 Practice locations: Prescott Valley, AZ

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AZ03540AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Sleepmatters, PLC CurrentSince Feb 6, 2022 Accepting new patients
Ashvin K. Shah, M.D., PC Past Accepting new patients

Locations

10134 N Oracle Rd
Ste 170
Tucson, AZ 85704
Phone (520) 848-3889

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1366495087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10134 N ORACLE RD STE 170",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857047612",
            "telephone_number": "520-848-3889",
            "fax_number": "520-989-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10134 N ORACLE RD STE 170",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857047612",
            "telephone_number": "520-848-3889",
            "fax_number": "520-989-3134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8841 E Florentine Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863148776",
            "country_code": "US",
            "telephone_number": "928-778-4555",
            "fax_number": "928-778-4560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "JAMES",
        "middle_name": "CLINTON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "AZ03540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oro Valley, AZ

Sources for this page

Verify at the official NPI Registry.