Cameron A Goetz, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2345-057 Issued in WI

Practice address

339 Reed Ave
Manitowoc, WI 54220-2020

Phone

(920) 320-8600

Fax

(920) 320-8662

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Froedtert Manitowoc Medical Group, LLCGroup PAC ID 2365836954, 156 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St. Mary's Home for the Aged, Inc

  • Skilled Nursing Facility
  • Manitowoc, WI
  • NPI 1609882448

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Froedtert Manitowoc Medical Group, LLC

  dba Froedtert Northeast Medical Group

  • Multi-Specialty Clinic/Center
  • Manitowoc, WI
  • NPI 1437829975
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1932120607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2290",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542212290",
            "telephone_number": "920-320-8600",
            "fax_number": "920-320-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 REED AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202020",
            "telephone_number": "920-320-8600",
            "fax_number": "920-320-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETZ",
        "first_name": "CAMERON",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2345-057",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "2345-057",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00241039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "Q23775",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH PLAN",
            "identifier": "29439",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43576700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandria L Gezella, FNP-C
• Emily Gibbs, FNP-C
• Gineen Magiera Speech Pathology and Wellness LLC (Phoenix Swallowing Diagnostics)
• Pradeep Giriyappa, M.D.
• Sharon A Glandt, NP
• Dayna Marie Goetz, RN
• Shana Goodman, RN
• Rachel Gordon, LPC, CSAC, CAS
• Trish Luann Gordon
• Mary A Govier, M.D.

• Clinical Psychologist in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.