Organization Active NPI

Goul Family Medicine LLC

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1386331643
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GOUL FAMILY MEDICINE LLC
Practice address
5128 E Stop 11 Rd Ste 38
Indianapolis, IN 46237-6338
Phone
(317) 410-0371
NPI assigned
Apr 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Rhonda Wilson Goul, MDNPI 1023086725
Title
Owner
Phone
(317) 410-0371

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5128 E Stop 11 Rd Ste 38
Indianapolis, IN 46237-6338

Mailing address

5128 E Stop 11 Rd Ste 38
Indianapolis, IN 46237-6338
Phone (317) 410-0371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230515002497 IN Part B Supplier - Clinic/Group Practice 0143686204 Receives reassigned benefits from 1 practitioner
Practice locations: Indianapolis, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2281366Goul Family Medicine LLC5128 E Stop 11 Rd Ste 38, Indianapolis, IN 46237Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory

Locations

5128 E Stop 11 Rd
Ste 38
Indianapolis, IN 46237
Phone (317) 410-0371

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1386331643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5128 E STOP 11 RD STE 38",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376338",
            "telephone_number": "317-410-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5128 E STOP 11 RD STE 38",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376338",
            "telephone_number": "317-410-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOUL FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "GOUL",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-410-0371",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.