NPIMap

Individual provider Active NPI

Jeremy LR Goodwin, MS, MD

  • Neurology Physician
  • Petaluma, CA
National Provider Identifier
1366547614
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
G76323 Issued in CA
Practice address
1456 Professional Dr Ste 402
Petaluma, CA 94954-6639
Phone
(707) 938-7951
Fax
(707) 938-7260
NPI assigned
Sep 13, 2006
Last updated
Jun 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X G76323 CA Primary
Pain Medicine Physician 208VP0000X G76323 CA

Addresses

Primary practice location

1456 Professional Dr Ste 402
Petaluma, CA 94954-6639

Mailing address

1456 Professional Dr Ste 402
Petaluma, CA 94954-6639
Phone (707) 938-7951

Other identifiers 2

IdentifierTypeStateIssuer
R113031OtherORNORIDAN
138326OtherOROMAP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090928000295 CA Practitioner - NeurologyPractitioner - Pain Management 4880662691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pain Management
Education
University of Cincinnati College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sonoma Pain Management, IncGroup PAC ID 9234309683, 2 clinicians

Practice addresses (Care Compare)

1456 Professional Dr
Suite 402
Petaluma, CA 94954-6639
Phone (707) 938-7951

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.9 of 100Reported as group
Quality
81.89
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine, Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Sonoma Pain Management, Inc Neurology CurrentSince Nov 1, 2022 Accepting new patients
Interventional Pain Solutions PC Pain Medicine Past Accepting new patients
Bear Creek Physical Therapy Past Accepting new patients
Sonoma Valley Health Care District PastSince Nov 1, 2022 Accepting new patients
Mt Shasta Cardiology, Inc Past Accepting new patients

Locations

1456 Professional Dr
Ste 402
Petaluma, CA 94954
Phone (707) 781-9566

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1366547614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1456 PROFESSIONAL DR STE 402",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546639",
            "telephone_number": "707-938-7951",
            "fax_number": "707-938-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1456 PROFESSIONAL DR STE 402",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546639",
            "telephone_number": "707-938-7951",
            "fax_number": "707-938-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "JEREMY",
        "middle_name": "LR",
        "name_prefix": "Dr.",
        "credential": "MS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G76323",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "G76323",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDAN",
            "identifier": "R113031",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP",
            "identifier": "138326",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

Verify at the official NPI Registry.