Gary Morgan Goudelock, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

10729 Issued in SC

Practice address

20 Medical Ridge Dr
Greenville, SC 29605-4267

Phone

(864) 220-7270

Fax

(864) 241-9211

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Greenville Health System

  • General Acute Care Hospital
  • Greenville, SC
  • NPI 1568532513
  Medicare reassignment NPD
• Greenville Health System

  • General Acute Care Hospital
  • Greenville, SC
  • NPI 1225453269
  NPD

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457342461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MEDICAL RIDGE DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054267",
            "telephone_number": "864-220-7270",
            "fax_number": "864-241-9211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDELOCK",
        "first_name": "GARY",
        "middle_name": "MORGAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "10729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107299",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aimee Goss, APRN, FNP-C
• Alaina Holroyd Goss, RN
• Stacy Goss, LMT
• Matthew Ryan Gossage, M.D.
• Dawn Marie Gossett, C.P.S.S.
• Robert I Goulart, CRNA
• Phillip David Gould, DMD
• Janey Capers Newland Gour
• Scott Gourley, PHARMD
• Ana Elizabeth Gowani, MD

• Pediatrics Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.