Individual provider Active NPI

Stephen Norman Goldman, MA CCC

  • Speech-Language Pathologist
  • San Diego, CA
National Provider Identifier
1497032494
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP4743 Issued in CA
Practice address
200 W Arbor Dr # 8775
San Diego, CA 92103-1911
Phone
(619) 543-6530
Fax
(619) 543-7808
NPI assigned
Nov 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP4743 CA Primary

Addresses

Primary practice location

200 W Arbor Dr # 8775
San Diego, CA 92103-1911

Mailing address

200 West Arbor Drive Mailcode 8775
San Diego, CA 92103
Phone (619) 543-6530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
SP4743CAMDSpeech-Language Pathologist
4743CAMDClinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1497032494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WEST ARBOR DRIVE MAILCODE 8775",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-543-6530",
            "fax_number": "619-543-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR # 8775",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031911",
            "telephone_number": "619-543-6530",
            "fax_number": "619-543-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "STEPHEN",
        "middle_name": "NORMAN",
        "name_prefix": "Mr.",
        "credential": "MA CCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP4743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.