Individual provider Active NPI

Andrew Daniel Goldberg, M.D.

  • Emergency Medicine Physician
  • Portland, OR
National Provider Identifier
1932405594
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A107694 Issued in CA
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-3447
NPI assigned
Jan 31, 2011
Last updated
May 18, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A107694 CA Primary
Emergency Medicine Physician 207P00000X MD162199 OR
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 105731 MN
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 54427 MN
Critical Care Medicine (Internal Medicine) Physician 207RC0200X MD162199 OR

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3801 Miranda Ave
Palo Alto, CA 94304-1207
Phone (650) 493-5000

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN
ENROLLEDMedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160610000534 CA Practitioner - Emergency MedicinePractitioner - Critical Care (Intensivists) 5597936997 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.74 of 100Reported as group
Quality
66.48
Promoting interoperability
100
Improvement activities
40
Cost
75.97

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A107694CAMDEmergency Medicine Physician
MD162199ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Township Medical Foundation Critical Care Medicine CurrentSince Feb 14, 2017 Accepting new patients
Alameda Health System CurrentSince Apr 30, 2016 Accepting new patients
Washington Township Medical Foundation CurrentSince Feb 14, 2017 Accepting new patients
Alameda Health System CurrentSince Apr 30, 2016 Accepting new patients
Washington Township Medical Group Past Accepting new patients

Locations

2000 Mowry Ave
Fremont, CA 94538
Phone (510) 793-6653

39500 Fremont Blvd
Ste 100
Fremont, CA 94538
Phone (510) 248-1800

664 Southland Mall
Hayward, CA 94545
Phone (510) 266-1700

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

Interoperability endpoints

  • Direct secure messaging: agoldberg96153@direct.whhs.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463529600000",
    "number": "1932405594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 MIRANDA AVE",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041207",
            "telephone_number": "650-493-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "ANDREW",
        "middle_name": "DANIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-31",
        "last_updated": "2016-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A107694",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD162199",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MN",
            "license": "105731",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MN",
            "license": "54427",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "OR",
            "license": "MD162199",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.