Active NPI
Elicia Goodale
- Anatomic Pathology & Clinical Pathology Physician
- Charleston, SC
National Provider Identifier
1730703844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- LL84322
- Practice address
- 171 Ashley Ave # Msc908
Charleston, SC 29425-0100 - Phone
- (843) 792-1086
- NPI assigned
- Jun 4, 2020
- Last updated
- Jun 4, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | LL84322 | SC | Primary |
Addresses
Primary practice location
171 Ashley Ave # Msc908
Charleston, SC 29425-0100
Mailing address
171 Ashley Ave # Msc908
Charleston, SC 29425-0100
Phone (843) 792-1086
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591228800000",
"number": "1730703844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 ASHLEY AVE # MSC908",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294250100",
"telephone_number": "843-792-1086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 ASHLEY AVE # MSC908",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294250100",
"telephone_number": "843-792-1086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODALE",
"first_name": "ELICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-04",
"last_updated": "2020-06-04",
"certification_date": "2020-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "SC",
"license": "LL84322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.