Jesse Goodman, AGNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95003286 Issued in CA

Practice address

17782 Cowan Ste a
Irvine, CA 92614-6041

Phone

(949) 722-7118

NPI assigned

Oct 22, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, UT, ID3 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jason Kellogg MD IncGroup PAC ID 9032266127, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Jason Kellogg M.D. Inc

  • Psychiatry Physician
  • Newport Beach, CA
  • NPI 1235391624
  Medicare reassignment Care Compare group NPD
• Nutrix Utah PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Herriman, UT
  • NPI 1396689998
  NPD Authorized official
• Nutrix Utah PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Herriman, UT
  • NPI 1487427340
  NPD Authorized official
• H Squared Health

  • Internal Medicine Physician
  • La Mesa, CA
  • NPI 1982210183
  NPD

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1609248202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28411 PUEBLO DR",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926791157",
            "telephone_number": "801-425-2831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17782 COWAN STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146041",
            "telephone_number": "949-722-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "JESSE",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-22",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95003286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Good Vibes Hospitality of Oc, Inc
• Mahvash S Goodarzi
• Mona Goodarzi, DDS
• Janet Goodfellow, M.D
• Margot Goodkin, MD
• Jack Goodrich
• Dina Tadeana Gordillo, BCBA
• Gordon Psychology Group, PC
• Meredith Gordon Resnick, LCSW
• Catherine Gordon, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Irvine, CA
• Providers in Irvine, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.