Craig Brad Goren, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001843 Issued in VA

Practice address

617 Potomac Station Dr NE
Suite a
Leesburg, VA 20176-1817

Phone

(703) 669-4646

Fax

(703) 991-0514

NPI assigned

Jun 30, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Pennsylvania State University College of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Halethorpe, MD
  • NPI 1043378656
  Medicare reassignment Care Compare group NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Annapolis, MD
  • NPI 1952461816

  DC, Optometrist

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • MC Lean, VA
  • NPI 1376815472
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Halethorpe, MD
  • NPI 1417294984
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD
• Bethesda Optometry LLC

  • Optometrist
  • Bethesda, MD
  • NPI 1568687028
  NPD (past)

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1528296456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD",
            "address_2": "SUITE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823990",
            "telephone_number": "703-847-8899",
            "fax_number": "703-991-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 POTOMAC STATION DR NE",
            "address_2": "SUITE A",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201761817",
            "telephone_number": "703-669-4646",
            "fax_number": "703-991-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOREN",
        "first_name": "CRAIG",
        "middle_name": "BRAD",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-30",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "617 Potomac Station Dr NE",
            "address_2": "Suite A",
            "city": "Leesburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201761817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aubrey Christine Goodwin, NP
• Elizabeth (Betsy) G Goodwin, LCSW
• Nancy H Gordon, MA, CCC-SLP
• Gavin Blair Gore
• Wayne Bruce Gore, MED, CSAC
• Alaina Marie Gotwalt, CCC-SLP
• Gooya Goudarzi, OD
• Shannon M Gould
• Maria Cecilia Grady, P.T.
• Grafton School, Inc.

• Optometrist in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.