Individual provider Active NPI

Christopher K Goodwin, M.D.

  • Pediatrics Physician
  • Portage, MI
National Provider Identifier
1558306944
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
40268 Issued in KY
Practice address
2680 W Centre Ave
Portage, MI 49024-4828
Phone
(269) 324-2400
Fax
(269) 327-0450
NPI assigned
Jun 18, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 40268 KY
Pediatrics Physician 208000000X 40268 KY Primary

Addresses

Primary practice location

2680 W Centre Ave
Portage, MI 49024-4828

Mailing address

2680 W Centre Ave
Portage, MI 49024-4828
Phone (269) 324-2400

Other identifiers 4

IdentifierTypeStateIssuer
1417961137OtherMIBCBSM - BMH
1558306944MedicaidMI
0C910950OtherMIBCBSM
1104840529OtherMIBCBSM - BMG

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20090729000173 MI Practitioner - Pediatric MedicinePractitioner - Internal Medicine 3375640527 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40268KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital CurrentSince Aug 1, 2009 Accepting new patients
Bronson Practice Management Internal Medicine Past Accepting new patients
Bronson Methodist Hospital Past Accepting new patients

Locations

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
#2
Kalamazoo, MI 49007

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

2680 W Centre Ave
Portage, MI 49024
Phone (269) 324-2400

Interoperability endpoints

  • Direct secure messaging: cgoodwin10496@direct.bronsonhg.org
  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1558306944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244828",
            "telephone_number": "269-324-2400",
            "fax_number": "269-327-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244828",
            "telephone_number": "269-324-2400",
            "fax_number": "269-327-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "CHRISTOPHER",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "40268",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "40268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BMH",
            "identifier": "1417961137",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558306944",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0C910950",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BMG",
            "identifier": "1104840529",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.