Active NPI
Derrick D. Goodwill, M.S., PA-C
- Medical Physician Assistant
- Sugar Land, TX
National Provider Identifier
1821122243
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Dec 20, 2016.
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA04820
- Practice address
- 1935 Lakeside Plaza Dr
Sugar Land, TX 77479-4226 - Phone
- (281) 491-0413
- NPI assigned
- Mar 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA04820 | TX | Primary |
Addresses
Primary practice location
1935 Lakeside Plaza Dr
Sugar Land, TX 77479-4226
Mailing address
1935 Lakeside Plaza Dr
Sugar Land, TX 77479-4226
Phone (281) 491-0413
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA04820 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315958400000",
"number": "1821122243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1935 LAKESIDE PLAZA DR",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774794226",
"telephone_number": "281-491-0413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1935 LAKESIDE PLAZA DR",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774794226",
"telephone_number": "281-491-0413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWILL",
"first_name": "DERRICK",
"middle_name": "D.",
"name_prefix": "Mr.",
"credential": "M.S., PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2011-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA04820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sugar Land, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.