Susan Mavis Goltz, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

33349 Issued in MN

Practice address

1000 E 1St St
Ste. LL
Duluth, MN 55805-2297

Phone

(218) 722-5629

Fax

(218) 722-5148

NPI assigned

Mar 15, 2006

Sex

Female

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 8

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Northland OB-GYN Associates

  • Medical Specialty Clinic/Center
  • Duluth, MN
  • NPI 1043397870
  NPD

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1811966500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST",
            "address_2": "STE. LL",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-5629",
            "fax_number": "218-722-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST",
            "address_2": "STE. LL",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-5629",
            "fax_number": "218-722-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLTZ",
        "first_name": "SUSAN",
        "middle_name": "MAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "33349",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "33349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "111079",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31754000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A005",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2055782400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0725685",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2F932SW",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "346005",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP22608",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "1000 E 1st St",
            "address_2": "Ste. LL",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558052297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael James Gogolin, ATC
• Stephanie Gogolin, ATC
• Patricia Lynn Goldberg, FNP
• Eric Steven Goldschmidt, M.D.
• Peter Gordon Goldschmidt, M.D.
• Kristin Marie Goman
• Jose Enrique Gomez, MD, PHD
• Penelope Jean Gooch, MS LP
• Samantha Good Nelson, PA-S
• Peter Alan Good, MD

• Obstetrics & Gynecology Physician in Duluth, MN
• Providers in Duluth, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.