Active NPI
Heidi Goetz, MD
- Anesthesiology Physician
- Portland, OR
National Provider Identifier
1376519207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD15962
- Practice address
- 425 SW Alderidge Dr
Portland, OR 97225-6449 - Phone
- (503) 292-5624
- Fax
- (503) 297-4714
- NPI assigned
- Feb 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD15962 | OR | Primary |
| Critical Care Medicine (Anesthesiology) Physician | 207LC0200X | MD15962 | OR |
Addresses
Primary practice location
425 SW Alderidge Dr
Portland, OR 97225-6449
Mailing address
425 SW Alderidge Dr
Portland, OR 97225-6449
Phone (503) 292-5624
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 068973 | Medicaid | OR | |
| 1051523 | Medicaid | WA | |
| XPY197514 | Medicaid | CA | |
| MD244OR | Medicaid | AK | |
| 050041429 | Other | OR | RR MEDICARE |
| 1376519207 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD15962 | OR | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475280000000",
"number": "1376519207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 SW ALDERIDGE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256449",
"telephone_number": "503-292-5624",
"fax_number": "503-297-4714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 SW ALDERIDGE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256449",
"telephone_number": "503-292-5624",
"fax_number": "503-297-4714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZ",
"first_name": "HEIDI",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-28",
"last_updated": "2016-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OR",
"license": "MD15962",
"primary": true
},
{
"code": "207LC0200X",
"taxonomy_group": "",
"desc": "Anesthesiology, Critical Care Medicine",
"state": "OR",
"license": "MD15962",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "068973",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1051523",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XPY197514",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD244OR",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "050041429",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1376519207",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.