NPIMap

Organization Active NPI

Mitchell R Goldstein, MD

  • Professional Counselor
  • South Bend, IN
National Provider Identifier
1700196698
Registry record updated Oct 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MITCHELL R GOLDSTEIN, MD
Practice address
107 N Eddy St
South Bend, IN 46617-2920
Phone
(574) 532-0153
Fax
(574) 246-1634
NPI assigned
Oct 14, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2010

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

Authorized official

Name
Dr. Mitchell Robert Goldstein, MDNPI 1659335636
Title
Owner
Phone
(574) 532-0153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

107 N Eddy St
South Bend, IN 46617-2920

Mailing address

107 N Eddy St
South Bend, IN 46617-2920
Phone (574) 532-0153

Other identifiers 1

IdentifierTypeStateIssuer
100346980BMedicaidIN

National Provider Directory

National Provider Directory

Locations

107 N Eddy St
South Bend, IN 46617
Phone (574) 246-1036

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1700196698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172920",
            "telephone_number": "574-532-0153",
            "fax_number": "574-246-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172920",
            "telephone_number": "574-532-0153",
            "fax_number": "574-246-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL R GOLDSTEIN, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-14",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-532-0153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100346980B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; 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.