Individual provider Active NPI

Robert Joseph Goulet Jr., MD

  • Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1447217104
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01035324A Issued in IN
Practice address
7120 Clearvista Dr Ste 3200
Indianapolis, IN 46256-1782
Phone
(317) 621-7780
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01035324A IN Primary

Addresses

Primary practice location

7120 Clearvista Dr Ste 3200
Indianapolis, IN 46256-1782

Mailing address

6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2805

Other identifiers 4

IdentifierTypeStateIssuer
000000687809OtherINANTHEM PIN
000000780843OtherINANTHEM
P01218740OtherINRR MEDIARE PTAN
100354730MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgoulet9444@eCommunityDirect.com Community Physicians of Indiana Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20051228000239 IN Practitioner - General Surgery 1254353774 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Nov 7, 2012 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Nov 7, 2012 Accepting new patients
University Surgeons, Inc. Surgery CurrentSince Jan 1, 2006 Accepting new patients
Major Hospital Past Accepting new patients
University General Surgeons, Inc. Surgery Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

7630 Solutions Ctr
Chicago, IL 60677

1400 N Ritter Ave
Ste 485
Indianapolis, IN 46219
Phone (317) 355-2727

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

8040 Clearvista Pkwy
Ste 290
Indianapolis, IN 46256
Phone (317) 621-0401

545 Barnhill Dr
#239
Indianapolis, IN 46202
Phone (317) 274-3616

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

545 Barnhill Dr
#246
Indianapolis, IN 46202
Phone (317) 274-4922

7120 Clearvista Dr
Ste 3200
Indianapolis, IN 46256
Phone (317) 621-7780

3504 S Lafountain St
Kokomo, IN 46902
Phone (765) 453-8439

3500 S Lafountain St
Kokomo, IN 46902
Phone (765) 453-0702

Interoperability endpoints

  • Direct secure messaging: rgoulet9444@ecommunitydirect.com

Organizations & group practices 5

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1447217104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 CLEARVISTA DR STE 3200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561782",
            "telephone_number": "317-621-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULET",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01035324A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000687809",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000780843",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDIARE PTAN",
            "identifier": "P01218740",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100354730",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgoulet9444@eCommunityDirect.com",
            "affiliation": "Y",
            "affiliationName": "Community Physicians of Indiana Inc",
            "address_1": "8040 Clearvista Parkway",
            "address_2": "Suite 290",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462565604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.