Carol Ann Goodman MD LLC
Organization Active NPI Family Medicine Physician · Evansville, IN
NPI 1366747347 · NPPES record last updated Mar 23, 2023
Key facts
- NPI
- 1366747347
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAROL ANN GOODMAN MD LLC
- Practice address
- 1909 W Franklin St
Evansville, IN 47712-5110 - Phone
- (812) 456-9736
- Fax
- (812) 456-0140
- NPI assigned
- Jan 21, 2011
- Organization subpart
- No
Authorized official
- Name
- Carol Ann Goodman, MD
- Title
- MD
- Phone
- (812) 456-9736
Practitioners 14
-
Lisa Diann Beyers, APRN
-
David M Hayes, M.D.
-
Olivia Snepp, NP
-
Mellisa A Hall, N.P.
-
Paul M Kramer, M.D.
-
Lauren N Martin, FNP-BC
-
Megan E Mayes, NP
-
Amanda Jean Orr, FNP-C
-
Sarah Ellen Poag, NP
-
Jeffrey D Hunter, MD
-
Jon Scott Uloth, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2020255 | Carol Ann Goodman LLC | Provider-performed microscopy | Feb 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241125003532 | IN | Part B Supplier - Clinic/Group Practice | 8628253879 |
Receives reassigned benefits from 12 practitioners Practice locations: Evansville, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
1909 W Franklin St
Evansville, IN 47712-5110
Mailing address
1909 W Franklin St
Evansville, IN 47712-5110
Phone (812) 456-9736
NPI Registry JSON
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679529600000",
"number": "1366747347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1909 W FRANKLIN ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477125110",
"telephone_number": "812-456-9736",
"fax_number": "812-456-0140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 W FRANKLIN ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477125110",
"telephone_number": "812-456-9736",
"fax_number": "812-456-0140"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROL ANN GOODMAN MD LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-01-21",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A",
"authorized_official_last_name": "GOODMAN",
"authorized_official_first_name": "CAROL",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "812-456-9736",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
- David J Carlson
- Laura M Carlton
- Brian J Carmack
- Jennifer Carnahan
- Tather Carnahan
- Paige Carpenter
- Abbey Carr
- Hamilton Jacob Carr
- Lesa A Carr
- Melissa Carr
All providers in Evansville, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.