Individual provider Active NPI

Jill Patrice Goodwin-Smith, RN

  • Registered Nurse
  • Detroit, MI
National Provider Identifier
1861120479
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
4704210350 Issued in MI
Practice address
90 Westminster St
Detroit, MI 48202-1628
Phone
(313) 414-4583
NPI assigned
Aug 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704210350 MI Primary

Addresses

Primary practice location

90 Westminster St
Detroit, MI 48202-1628

Mailing address

4646 John R St
Detroit, MI 48201-1916
Phone (313) 576-1000

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704210350MIMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1861120479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 WESTMINSTER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482021628",
            "telephone_number": "313-414-4583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN-SMITH",
        "first_name": "JILL",
        "middle_name": "PATRICE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704210350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.