Active NPI
Dennis Stephen Goodman, DO
- Geriatric Medicine (Family Medicine) Physician
- Rolla, MO
National Provider Identifier
1720169709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- RSB71
- Practice address
- 715 St RT CC
Rolla, MO 65401 - Phone
- (573) 308-7386
- Fax
- (573) 341-5300
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | RSB71 | MO | Primary |
Addresses
Primary practice location
715 St RT CC
Rolla, MO 65401
Mailing address
PO Box 918
Rolla, MO 65402
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080052033 | Other | MO | RAILROAD MEDICARE |
| 241605948 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RSB71 | MO | MD | Geriatric Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1720169709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 918",
"city": "ROLLA",
"state": "MO",
"postal_code": "65402",
"fax_number": "573-341-5300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 ST RT CC",
"city": "ROLLA",
"state": "MO",
"postal_code": "65401",
"telephone_number": "573-308-7386",
"fax_number": "573-341-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "DENNIS",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MO",
"license": "RSB71",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080052033",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "241605948",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.