Andrea Marie Goodman, MSPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2017-0087 Issued in NM

Practice address

Msc06 3870 1 University of New Mexico
Albuquerque, NM 87131

Phone

(505) 277-3136

NPI assigned

Oct 20, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Southern Illinois University

  • Clinic/Center
  • E Saint Louis, IL
  • NPI 1306273776
  NPD (past)

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1699050781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HOLIDAY LOOP",
            "city": "TIJERAS",
            "state": "NM",
            "postal_code": "870597896",
            "telephone_number": "618-697-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MSC06 3870 1 UNIVERSITY OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87131",
            "telephone_number": "505-277-3136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "374 E Grand Ave",
            "address_2": "Mail Code 6740",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629013962",
            "country_code": "US",
            "telephone_number": "618-453-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "374 E Grand Ave",
            "address_2": "Mail Code 6740",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629013962",
            "country_code": "US",
            "telephone_number": "618-453-3311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-20",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004195",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2017-0087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY OF NEW MEXICO STUDENT HEALTH AND COUNSELING",
            "identifier": "1750550067",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles J Goodis, DDS
• Robert Wicksman Goodkind, PH.D.
• Kevin Goodluck, MD
• Thomas N Goodluck, LADA
• Jolie Goodman-Leibof
• Cheryl Lynn Goodman, PCC
• Elena Goodman
• James S. Goodman, M.D.
• Janay Goodman, PLMSW
• Lauren Allison Goodman

• Physician Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.