Jesse Adam Goodman, M.D.
Individual provider Active NPI Psychiatry Physician · Lenox, MA
NPI 1922011246 · NPPES record last updated Feb 3, 2022
Key facts
- NPI
- 1922011246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 160625 (MA)
- Practice address
- 38 Church St
Suite 101
Lenox, MA 01240-2525 - Phone
- (413) 637-2300
- Fax
- (888) 443-7405
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Mayo Medical School, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
38 Church St
Suite 1
Lenox, MA 01240-2528
Phone (413) 637-2300
Hospital & facility affiliations
- Fairview Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040107000803 | MA | Practitioner - Psychiatry | 6800795972 | Practice locations: Lenox, MA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- jessegoodmanmd@137784.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 160625 | MA | Yes |
Addresses
Primary practice location
38 Church St
Suite 101
Lenox, MA 01240-2525
Mailing address
38 Church St
Suite 101
Lenox, MA 01240-2525
Phone (413) 637-2300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J26890 | Other | MA | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS |
| 2299118580 | Other | MA | UNITED HEALTHCARE |
| 2021528 | Medicaid | MA |
Other providers in Lenox, MA
- Jean Friedman
- Kathleen D Friend
- Genesis Healthcare
- Cynthia J Geyer
- Paul Edwin Glass III
- Annette Quatrano Gour
- Robyn F Graham
- Louise Grant
- Herbert Eldon Gregg
- Anne N. Grosser
All providers in Lenox, MA · Psychiatry Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2022. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.