Jack Goldstein, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

17987 Issued in TN

Practice address

325 N State of Franklin Rd
2ND Floor
Johnson City, TN 37604

Phone

(423) 439-7280

Fax

(423) 493-7314

NPI assigned

Sep 29, 2006

Last updated

Aug 22, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Education Assistance Corporation

  dba ETSU Physicians and Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment NPD

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1457443228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-7280",
            "fax_number": "423-439-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD",
            "address_2": "2ND FLOOR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-7280",
            "fax_number": "423-493-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSTEIN",
        "first_name": "JACK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "17987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Gregory Gogan, BA
• Amie Douthat Goins
• Christopher S Golden, CRNA
• Deanna Antonia Golden, MS, RD
• Kristie Nicole Golden, PHARM.D.
• Shrey Gole, MD
• Wesley N Goltry
• Jessica C Golz, COTA/L
• Frederico Augusto Gomes-Filho, MD
• Roxanne Gonzalez

• Internal Medicine Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.