Individual provider Active NPI

Martha Hoffman Goedert, CNM. FNP, PHD,FACNM

  • Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1710067327
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60031352 Issued in WA
Practice address
6288 Glenwood Rd
Omaha, NE 68132-1854
Phone
(402) 990-5250
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 51363 NE
Family Nurse Practitioner 363LF0000X 110117 NE
Advanced Practice Midwife 367A00000X 120006 NE
Nurse Practitioner 363L00000X AP60031352 WA Primary

Addresses

Primary practice location

6288 Glenwood Rd
Omaha, NE 68132-1854

Mailing address

6288 Glenwood Rd
Omaha, NE 68132-1854
Phone (402) 990-5250

Other identifiers 2

IdentifierTypeStateIssuer
470765154OtherIAFEDERAL ID NUMBER
0420166MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Nurse Practitioner, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
51363NEMDRegistered Nurse
110117NEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jan 18, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Feb 20, 2024 Accepting new patients

Locations

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

3425 SE 192nd Ave
Ste 106
Vancouver, WA 98683
Phone (360) 205-2960

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.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1710067327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6288 GLENWOOD RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681321854",
            "telephone_number": "402-990-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6288 GLENWOOD RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681321854",
            "telephone_number": "402-990-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEDERT",
        "first_name": "MARTHA",
        "middle_name": "HOFFMAN",
        "credential": "CNM. FNP, PHD,FACNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NE",
            "license": "51363",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "110117",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NE",
            "license": "120006",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60031352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID NUMBER",
            "identifier": "470765154",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0420166",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.