Brody Wayne Goodwine, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12012698A Issued in IN

Practice address

7950 N Shadeland Ave Ste 200
Indianapolis, IN 46250-2692

Phone

(317) 596-9700

Fax

(317) 350-1342

NPI assigned

Jun 8, 2017

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 IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Goodwine Dental, LLC

  dba Northview Dental

  • Dental Clinic/Center
  • Indianapolis, IN
  • NPI 1376218909
  NPD

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1659800134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7950 N SHADELAND AVE STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502692",
            "telephone_number": "317-596-9700",
            "fax_number": "317-350-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 N SHADELAND AVE STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502692",
            "telephone_number": "317-596-9700",
            "fax_number": "317-350-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWINE",
        "first_name": "BRODY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012698A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Goodwill Industries of Central Indiana
• Andrea Jo Goodwin, MSW
• Meredith Lauren Goodwin, PA-C
• Valerie Ann Goodwin, OT
• Goodwine Dental, LLC (Northview Dental)
• Gopi Krishn Gorantla
• Courtney Elese Gorbandt, CCC-SLP
• Gregory Gorden
• Katherine E. Gorden, RPH
• Lauren Michelle Gorden, PA-C

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; 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.