Individual provider Active NPI

Mark A Goodman, MD

  • Cardiovascular Disease Physician
  • Garden City, NY
National Provider Identifier
1427014810
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
101625 Issued in NY
Practice address
975 Stewart Ave
Garden City, NY 11530-4816
Phone
(516) 222-8610
Fax
(516) 745-5476
NPI assigned
Apr 25, 2006
Last updated
Feb 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 101625 NY Primary

Addresses

Primary practice location

975 Stewart Ave
Garden City, NY 11530-4816

Mailing address

975 Stewart Ave
Garden City, NY 11530-4816
Phone (516) 222-8610

Other identifiers 1

IdentifierTypeStateIssuer
00439107MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgoodman222149@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100518000015 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6406741396 Reassigns benefits to 1 organization
I20200108001039 FL Practitioner - Cardiovascular Disease (Cardiology) 6406741396 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
101625NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
New York University Cardiovascular Disease CurrentSince Oct 1, 2018 Accepting new patients
New York University Cardiovascular Disease CurrentSince Oct 1, 2018 Accepting new patients
Medical Group of Mineola, PC Past Accepting new patients
Winthrop Community Medical Affiliates PC Cardiovascular Disease Past Accepting new patients

Locations

16244 S Military Trl
Ste 560
Delray Beach, FL 33484
Phone (561) 495-7787

975 Stewart Ave
Garden City, NY 11530
Phone (516) 222-8600

975 Stewart Ave
#A
Garden City, NY 11530
Phone (516) 222-8600

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1427014810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 STEWART AVE",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304816",
            "telephone_number": "516-222-8610",
            "fax_number": "516-745-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 STEWART AVE",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304816",
            "telephone_number": "516-222-8610",
            "fax_number": "516-745-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "101625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00439107",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgoodman222149@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "975 Stewart Ave",
            "city": "Garden City",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115304816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

Verify at the official NPI Registry.