NPIMap

Individual provider Active NPI

Stephanie Diane Goeman, PA

  • Physician Assistant
  • Nashville, TN
National Provider Identifier
1508160482
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3391 Issued in TN
Practice address
1214 Gallatin Ave
Nashville, TN 37206-3242
Phone
(615) 988-1620
NPI assigned
Jan 6, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2115 KY
Medical Physician Assistant 363AM0700X 005991 GA
Physician Assistant 363A00000X 3391 TN Primary

Addresses

Primary practice location

1214 Gallatin Ave
Nashville, TN 37206-3242

Mailing address

1069 Lillian LN
Gallatin, TN 37066-4561
Phone (813) 389-2520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110520000353 GA Practitioner - Physician Assistant 1850577198 Reassigns benefits to 3 organizations
I20170719004086 TN Practitioner - Physician Assistant 1850577198 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3308TNMDSpeech-Language Pathologist
PA2115KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Otto C Goyco MD Internal Medicine LLC Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1508160482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 LILLIAN LN",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370664561",
            "telephone_number": "813-389-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 GALLATIN AVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372063242",
            "telephone_number": "615-988-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEMAN",
        "first_name": "STEPHANIE",
        "middle_name": "DIANE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-06",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2115",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "005991",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.