Bryan L Goddard, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

150318 Issued in NY

Practice address

2524 Route 9W
Ravena, NY 12143-2804

Phone

(518) 756-7390

Fax

(518) 756-8030

NPI assigned

Aug 31, 2005

Last updated

Jan 18, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Community Care Physicians, PLLC

  dba Community Care Family Practice Ballston Spa

  • Family Medicine Physician
  • Ballston Spa, NY
  • NPI 1548541246
  NPD (past)
• United Health Services Hospitals, Inc.

  • Multi-Specialty Clinic/Center
  • Johnson City, NY
  • NPI 1962463851
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1780678169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2524 ROUTE 9W",
            "city": "RAVENA",
            "state": "NY",
            "postal_code": "121432804",
            "telephone_number": "518-756-7390",
            "fax_number": "518-756-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODDARD",
        "first_name": "BRYAN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2008004918",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "150318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00751111",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENIOR WHOLE HEALTH",
            "identifier": "305800",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "6754C1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4228179",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "101115000088",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/HMO",
            "identifier": "642981",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "PRC110032213",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven L Essig, DDS
• Susan Flanagan
• Richard Anthony Galarza
• Philip M Gatti
• Mary Elizabeth R Giacoma, SLP
• Bridget D Goffredo
• Laura Anne Gottesman
• Eda Graham
• Kelly L Guilmette, SLP
• Timothy Leonard Haller, SLP

• Family Medicine Physician in Ravena, NY
• Providers in Ravena, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; 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.