Active NPI
Larry Scott Goldman, M.D.
- Psychiatry Physician
- Chicago, IL
National Provider Identifier
1851356752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036-059116
- Practice address
- 1 E Erie St
Suite 355
Chicago, IL 60611-2740 - Phone
- (312) 573-0900
- Fax
- (312) 573-1532
- NPI assigned
- Apr 20, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036-059116 | IL | Primary |
Addresses
Primary practice location
1 E Erie St
Suite 355
Chicago, IL 60611-2740
Mailing address
1 E Erie St Ste 355
Chicago, IL 60611-2772
Phone (312) 573-0900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036059116 | Medicaid | IL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-059116 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326672000000",
"number": "1851356752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 E ERIE ST STE 355",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112772",
"telephone_number": "312-573-0900",
"fax_number": "312-573-1532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E ERIE ST",
"address_2": "SUITE 355",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112740",
"telephone_number": "312-573-0900",
"fax_number": "312-573-1532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDMAN",
"first_name": "LARRY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2012-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036-059116",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036059116",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.