NPIMap

Individual provider Active NPI

Andrew Stanley Goebel

  • Psychologist
  • Menasha, WI
National Provider Identifier
1609320209
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3852 Issued in WI
Practice address
1095 Midway Rd
Menasha, WI 54952-1115
Phone
(920) 720-3700
NPI assigned
Aug 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3852 WI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1095 Midway Rd
Menasha, WI 54952-1115

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070

Other practice location 1

5100 Dowdell Ave Unit 204
Rohnert Park, CA 94928-4110
Phone (203) 873-8199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201125000012 WI Practitioner - Clinical Psychologist 8820408719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1095 Midway Rd
Menasha, WI 54952-1115
Phone (920) 720-2300

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160
  • Thedacare Medical Center - New London Hospital, New London, WI, CCN 521326

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3852WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Oct 5, 2020 Accepting new patients
Thedacare, Incorporated Psychologist CurrentSince Oct 5, 2020 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1095 Midway Rd
Menasha, WI 54952
Phone (920) 720-3700

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

Organizations & group practices 2

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1609320209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521115",
            "telephone_number": "920-720-3700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5100 Dowdell Ave Unit 204",
            "address_purpose": "LOCATION",
            "city": "Rohnert Park",
            "state": "CA",
            "postal_code": "949284110",
            "country_code": "US",
            "telephone_number": "203-873-8199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOEBEL",
        "first_name": "ANDREW",
        "middle_name": "STANLEY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-11",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3852",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.