Michael R Goodman MD PC
Organization Active NPI Psychiatry Physician · Omaha, NE
NPI 1881903151 · NPPES record last updated Oct 4, 2010
Key facts
- NPI
- 1881903151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 18052 (NE)
- Legal business name
- MICHAEL R GOODMAN MD PC
- Practice address
- 9239 West Center Road
Suite 221
Omaha, NE 68124-1968 - Phone
- (402) 354-8025
- Fax
- (402) 354-8044
- NPI assigned
- Oct 4, 2010
- Organization subpart
- No
Authorized official
- Name
- Michael R Goodman, M.D.
- Title
- President
- Phone
- (402) 354-8025
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101123000605 | NE | Part B Supplier - Clinic/Group Practice | 3971799461 |
Receives reassigned benefits from 1 practitioner Practice locations: Omaha, NE |
National Provider Directory
Locations
9239 W Center Rd
Ste 221
Omaha, NE 68124
Phone (402) 354-8025
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | 18052 | NE | Yes |
Addresses
Primary practice location
9239 West Center Road
Suite 221
Omaha, NE 68124-1968
Mailing address
9239 West Center Road
Suite 221
Omaha, NE 68124-1968
Phone (402) 354-8025
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.