Individual provider Active NPI

La-Dricka Chiree Goodman

  • Case Manager/Care Coordinator
  • Kissimmee, FL
National Provider Identifier
1780056515
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
1216 Patrick St
Kissimmee, FL 34741-5534
Phone
(321) 236-1540
NPI assigned
Oct 20, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

1216 Patrick St
Kissimmee, FL 34741-5534

Mailing address

1216 Patrick St
Kissimmee, FL 34741-5534
Phone (321) 236-1540

Other practice location 1

2814 S US Highway 1
Suite D4
Fort Pierce, FL 34982-8120
Phone (772) 489-4726

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)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Serving Children and Reaching Families CurrentSince Apr 6, 2023 Accepting new patients
Suncoast Mental Health Center, Inc. Past Accepting new patients

Locations

1216 Patrick St
Kissimmee, FL 34741
Phone (321) 236-1540

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": "1445299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1780056515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 PATRICK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415534",
            "telephone_number": "321-236-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 PATRICK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415534",
            "telephone_number": "321-236-1540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2814 S US Highway 1",
            "address_2": "Suite D4",
            "address_purpose": "LOCATION",
            "city": "Fort Pierce",
            "state": "FL",
            "postal_code": "349828120",
            "country_code": "US",
            "telephone_number": "772-489-4726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "LA-DRICKA",
        "middle_name": "CHIREE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-20",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.