Individual provider Active NPI

Katrina Anne Godderz, M.D.

  • Emergency Medicine Physician
  • South Miami, FL
National Provider Identifier
1588911614
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME 122296 Issued in FL
Practice address
6200 SW 73Rd St
South Miami, FL 33143-4679
Phone
(786) 662-0455
NPI assigned
Aug 8, 2012
Last updated
Sep 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD177893 OR
Emergency Medicine Physician 207P00000X ME 122296 FL Primary

Addresses

Primary practice location

6200 SW 73Rd St
South Miami, FL 33143-4679

Mailing address

3250 Grand Ave
Apartment 310
Miami, FL 33133-5016
Phone (509) 315-6319

Other practice location 1

1046 6th Ave SW
Albany, OR 97321-1916
Phone (541) 812-4000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kgodderz666392@oc.providencedirect.org
Direct Messaging Address kgodderz260081@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, VI2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20161121000220 OR Practitioner - Emergency Medicine 7315251709 Reassigns benefits to 2 organizations
I20200924002387 VI Practitioner - Emergency Medicine 7315251709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 122296FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Feb 10, 2023 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Oct 4, 2020 Accepting new patients
Healogics Specialty Physicians of Oregon, LLC Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Oct 4, 2020 Accepting new patients

Locations

1046 6th Ave SW
Albany, OR 97321
Phone (541) 812-4000

375 SE Norton Ln
Ste A
McMinnville, OR 97128
Phone (503) 472-5749

875 Oak St SE
Salem, OR 97301
Phone (503) 561-5719

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423

Interoperability endpoints

  • Direct secure messaging: kgodderz666392@oc.providencedirect.org

Organizations & group practices 4

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": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1588911614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 GRAND AVE",
            "address_2": "APARTMENT 310",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331335016",
            "telephone_number": "509-315-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 SW 73RD ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331434679",
            "telephone_number": "786-662-0455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1046 6th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "OR",
            "postal_code": "973211916",
            "country_code": "US",
            "telephone_number": "541-812-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODDERZ",
        "first_name": "KATRINA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD177893",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME 122296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgodderz666392@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "725 S Wahanna Rd",
            "city": "Seaside",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971387735",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgodderz260081@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "1046 6th Ave SW",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973211916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Miami, FL

Sources for this page

Verify at the official NPI Registry.