Organization Active NPI

Putnam Heart Center PA

  • Cardiovascular Disease Physician
  • Palatka, FL
National Provider Identifier
1598878670
Registry record updated Dec 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME77178 Issued in FL
Legal business name
PUTNAM HEART CENTER PA
Practice address
6710 Old Wolf Bay Rd
Palatka, FL 32177-6830
Phone
(386) 326-1590
Fax
(386) 326-1591
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2009

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

Authorized official

Name
Dr. Mukesh Goel, M.D.NPI 1770618837
Title
Owner
Phone
(386) 326-1590

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X ME77178 FL Primary

Addresses

Primary practice location

6710 Old Wolf Bay Rd
Palatka, FL 32177-6830

Mailing address

6710 Old Wolf Bay Rd
Palatka, FL 32177-6830
Phone (386) 326-1590

Other identifiers 1

IdentifierTypeStateIssuer
264957800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041012001004 FL Part B Supplier - Clinic/Group Practice 8820058167 Receives reassigned benefits from 4 practitioners
Practice locations: Palatka, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0991646Putnam Heart Center PA6710 Old Wolfbay Road, Palatka, FL 32177AccreditationMay 15, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260835200000",
    "number": "1598878670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6710 OLD WOLF BAY RD",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321776830",
            "telephone_number": "386-326-1590",
            "fax_number": "386-326-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6710 OLD WOLF BAY RD",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321776830",
            "telephone_number": "386-326-1590",
            "fax_number": "386-326-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM HEART CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2009-12-15",
        "status": "A",
        "authorized_official_last_name": "GOEL",
        "authorized_official_first_name": "MUKESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-326-1590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME77178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264957800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palatka, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.