Individual provider Active NPI

Mitchell Goldman, DO

  • Emergency Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1871687806
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02001386 Issued in IN
Practice address
2001 W 86TH St
Indianapolis, IN 46260-1902
Phone
(317) 802-3140
Fax
(317) 870-0499
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 02001386 IN Primary

Addresses

Primary practice location

2001 W 86TH St
Indianapolis, IN 46260-1902

Mailing address

4685 Reliable Pkwy
Chicago, IL 60686-0001
Phone (317) 802-3140

Other identifiers 1

IdentifierTypeStateIssuer
200028500MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090414000090 IN Practitioner - Emergency Medicine 5193707891 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02001386INMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC Emergency Medicine CurrentSince Apr 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Apr 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Indiana Physician Management-Henry, LLC Emergency Medicine PastSince Jan 1, 2016 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

13861 Olio Rd
Fishers, IN 46037
Phone (317) 338-7136

2001 W 86th St
Indianapolis, IN 46260
Phone (317) 338-3617

2412 E Main St
Plainfield, IN 46168
Phone (317) 204-6800

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1871687806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "317-802-3140",
            "fax_number": "317-870-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W 86TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601902",
            "telephone_number": "317-802-3140",
            "fax_number": "317-870-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "MITCHELL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02001386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200028500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.