Active NPI
Geoffrey William Goodfellow, OD
- Optometrist
- Chicago, IL
National Provider Identifier
1407840838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046009341
- Practice address
- 3241 S Michigan Ave
Chicago, IL 60616-3849 - Phone
- (312) 225-6200
- Fax
- (312) 949-7660
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046009341 | IL | Primary |
Addresses
Primary practice location
3241 S Michigan Ave
Chicago, IL 60616-3849
Mailing address
3241 S Michigan Ave
Chicago, IL 60616-3849
Phone (312) 949-7016
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046009341 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois College of Optometry | Optometrist | Current | Accepting new patients |
Locations
3241 S Michigan Ave
Chicago, IL 60616
Phone (312) 225-6200
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- geoffrey.goodfellow.iei@direct.ico.nextgenshare.com
Organizations & group practices 1
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": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1407840838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3241 S MICHIGAN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606163849",
"telephone_number": "312-949-7016",
"fax_number": "312-949-7681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3241 S MICHIGAN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606163849",
"telephone_number": "312-225-6200",
"fax_number": "312-949-7660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODFELLOW",
"first_name": "GEOFFREY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046009341",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046009341",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.