Tasha Lee Godbolt
Individual provider Active NPI Adult Medicine Physician · Roselle Park, NJ
NPI 1457034951 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1457034951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Medicine Physician 207QA0505X
- Practice address
- 141 Chestnut St Ste 201
Roselle Park, NJ 07204-2282 - Phone
- (973) 223-2933
- NPI assigned
- Aug 10, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Nurse Practitioner Professional Resources
Practice addresses (Care Compare)
36 Cushman St
Lakewood, NJ 08701-5201
Phone (856) 885-4579
Hospital & facility affiliations
- Promise Care NJ
- Promise Care NJ
- Bayada Home Health Care Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Faith Hospice Care LLC |
Hospice | W-2 Managing Employee (25%) | Apr 19, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240131000896 | NJ | Practitioner - Nurse Practitioner | 8628421229 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nurse Practitioner Professional Resources | Current |
Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/26288/brand/1/csg/1/fhir/r4
- tasha.godbolt.1@26288.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 0 | NJ | Yes |
Addresses
Primary practice location
141 Chestnut St Ste 201
Roselle Park, NJ 07204-2282
Mailing address
141 Chestnut St Ste 201
Roselle Park, NJ 07204-2282
Phone (973) 223-2933
Other providers in Roselle Park, NJ
- Ricardo Garcia
- Garden State Dental Associates, LLC
- Joel C Gelbman
- Bindu P George
- Richard Edwin Glass
- Manuel Alcides Gonzalez
- Zaira Gonzalez
- Hada Care LLC
- Harmony Smiles LLC
- Diego Alberto Herrera Figueira
All providers in Roselle Park, NJ · Adult Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.