Charles Meyer Gooss, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DE60034731 Issued in WA

Practice address

102 N Fair Ave
Ste 102
Yakima, WA 98901

Phone

(509) 469-0875

Fax

(509) 469-0865

NPI assigned

May 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 23, 2015 through Sep 23, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226016000000",
    "number": "1922051093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N FAIR AVE",
            "address_2": "STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "98901",
            "telephone_number": "509-469-0875",
            "fax_number": "509-469-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N FAIR AVE",
            "address_2": "STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "98901",
            "telephone_number": "509-469-0875",
            "fax_number": "509-469-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOSS",
        "first_name": "CHARLES",
        "middle_name": "MEYER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401008092",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60034731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Naveen Prasad Gopalakrishnan Ravikumar, M.D.
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• Melissa R Gorsuch-Clark, M.S.W.
• Deepika S Goshike, MD

• All providers in Yakima, WA
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.