Active NPI
Maxwell Goodmanson
- Orthotist
- Saint Paul, MN
National Provider Identifier
1841968351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- 1104163187
- Practice address
- 360 Sherman St Ste 160
Saint Paul, MN 55102-2425 - Phone
- (651) 291-9000
- NPI assigned
- Aug 31, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthotist | 222Z00000X | 1104163187 | MN | Primary |
Addresses
Primary practice location
360 Sherman St Ste 160
Saint Paul, MN 55102-2425
Mailing address
360 Sherman St Ste 160
Saint Paul, MN 55102-2425
Phone (651) 291-9000
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104163187 | MN | MD | Orthotist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630972800000",
"number": "1841968351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 SHERMAN ST STE 160",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022425",
"telephone_number": "651-291-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 SHERMAN ST STE 160",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022425",
"telephone_number": "651-291-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMANSON",
"first_name": "MAXWELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-31",
"last_updated": "2021-09-07",
"certification_date": "2021-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "MN",
"license": "1104163187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.