Marijo Goodsite, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

400 N Pepper Ave
Colton, CA 92324-1801

Phone

(909) 580-1000

NPI assigned

Oct 2, 2012

Last updated

Oct 2, 2012By the provider in NPPES

Sex

Female

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 PA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Main Line Emergency Med Associates LLC

  • Emergency Medicine Physician
  • Paoli, PA
  • NPI 1316919368
  Medicare reassignment

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1619229564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 GREENWOOD HTS",
            "city": "BELLEVUE",
            "state": "OH",
            "postal_code": "448111049",
            "telephone_number": "419-217-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODSITE",
        "first_name": "MARIJO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Elisse Gonzalez
• Uriel Angel Gonzalez, LMFT
• Yudith Gonzalez
• Good Times Dental, Professional Corporation
• David Goodman
• John Tesco Goodson, LCSW
• Bennie Gordon Jr.
• Keith L Gordon III, M.D.
• Mehrnoush Gorjian, M.D.
• Linda Kay Gory

• Medical Physician Assistant in Colton, CA
• Providers in Colton, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.