Justin Davis Goldman, MA

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

15 Spinning Wheel Rd Ste 406
Hinsdale, IL 60521-5400

Phone

(773) 312-3612

NPI assigned

Jul 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovative Counseling Partners LLC

  • Adult Mental Health Clinic/Center
  • Oak Park, IL
  • NPI 1437563798
  Medicare reassignment NPD

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1770192130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 W LINCOLN HWY APT 9108",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601152908",
            "telephone_number": "650-815-5679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SPINNING WHEEL RD STE 406",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605215400",
            "telephone_number": "773-312-3612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7222 W Cermak Rd Ste 703",
            "address_purpose": "LOCATION",
            "city": "North Riverside",
            "state": "IL",
            "postal_code": "605461423",
            "country_code": "US",
            "telephone_number": "773-312-3612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "JUSTIN",
        "middle_name": "DAVIS",
        "name_prefix": "Mr.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel J Girgis, M.D.
• Tawfik Girgis, MD
• Victoria Glatz, RD, LDN
• Caroline Glocker
• Bernadette Gniadecki, D.O.
• Erin Golon, LCPC
• Maryam Moghadam Golshani, DDS
• Ilse G Gongora, OTR/L
• Dawn Gonzalez, FNP
• Lauren Wagner Gonzalez, LCSW

• Psychologist in Hinsdale, IL
• Providers in Hinsdale, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.