Alisa Stephanie Goulbourne-Scott, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0041901 Issued in NY

Practice address

19 Henrietta CT
Ridgewood, NJ 07450-2938

Phone

(201) 670-7498

NPI assigned

Apr 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

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

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189728000000",
    "number": "1942428255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HENRIETTA CT",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502938",
            "telephone_number": "201-670-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HENRIETTA CT",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502938",
            "telephone_number": "201-670-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULBOURNE-SCOTT",
        "first_name": "ALISA",
        "middle_name": "STEPHANIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "0041901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Goldstein, L. AC. , MTOM
• Danny J Gomez, D.P.M.
• Suzanne Goodwin
• Francine Gordon, LCSW
• Hamilton C Goulart, M.D.
• Janine N. Goulet, APN
• Patrick Bryan Granelli, LCSW
• Grant N Ko MD
• Juan B Grau, M.D.
• Julie M Grayson

• Physician Assistant in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.