Bradley Goldenberg, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

28322 Issued in MS

Practice address

15200 Community Rd
Gulfport, MS 39503-3085

Phone

(228) 575-7022

Fax

(228) 575-7097

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in IL, IN, OH, MS, AZ5 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 5

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.

• Singing River Gulfport

  • Multi-Specialty Clinic/Center
  • Gulfport, MS
  • NPI 1861010159
  Medicare reassignment NPD
• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937
  Medicare reassignment NPD
• Indiana University Health Ball Memorial Physicians, Inc.

  • Family Medicine Physician
  • Muncie, IN
  • NPI 1235455544
  Medicare reassignment NPD
• The Methodist Hospitals, Inc

  • Internal Medicine Physician
  • Gary, IN
  • NPI 1720290349
  Medicare reassignment NPD
• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414
  Medicare reassignment NPD
• Healthtap Medical Group, P.C.

  • General Practice Physician
  • Portola Valley, CA
  • NPI 1518330539

  AZ, IL, MS

  Medicare reassignment
• Singing River Health System

  • Internal Medicine Physician
  • Pascagoula, MS
  • NPI 1134283419
  NPD
• Indiana University Health Ball Memorial Physicians, Inc.

  • Internal Medicine Physician
  • Muncie, IN
  • NPI 1235152125

  Neonatal-Perinatal Medicine

  NPD
• The Methodist Hospitals, Inc

  • Neurology Physician
  • Gary, IN
  • NPI 1720290588
  NPD
• Midwest Neoped Associates LTD

  • Specialist
  • Oak Brook, IL
  • NPI 1396792180
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477595239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340",
            "telephone_number": "228-497-7576",
            "fax_number": "228-497-8869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033085",
            "telephone_number": "228-575-7022",
            "fax_number": "228-575-7097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Napoleon Ave",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701156914",
            "country_code": "US",
            "telephone_number": "504-842-3650",
            "fax_number": "504-894-2086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLDENBERG",
        "first_name": "BRADLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2023-03-07",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01070390A",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "WI",
            "license": "674",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "LA",
            "license": "329609",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036074881",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MS",
            "license": "28322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1J4304",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1L7105",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074881",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN STATE LICENSE",
            "identifier": "01070390A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098179",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSR",
            "identifier": "01070390B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000001071268",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Global One
• April Goacher
• Abraham R Gobel, MD
• Kaitlyn Goetsch, NP
• William Lacy Goff Jr., NP
• Brooke Kayla Gonzales, PHARMD
• Paola Nicol Gonzalez de Jesus
• Good Heart Professional Counseling
• Good Medicine
• Alicia Dorethea Goodman, FNP-C

• Neonatal-Perinatal Medicine Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Neonatal-Perinatal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.