Active NPI
Michael L. Goldstein, M.D.
- Neurology Physician
- Salt Lake City, UT
National Provider Identifier
1962400580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 156786 1205
- Practice address
- 1151 E 3900 S
# B150
Salt Lake City, UT 84124-1216 - Phone
- (801) 262-3441
- Fax
- (801) 269-9005
- NPI assigned
- Jul 8, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 156786 1205 | UT | Primary |
Addresses
Primary practice location
1151 E 3900 S
# B150
Salt Lake City, UT 84124-1216
Mailing address
1151 E 3900 S
# B150
Salt Lake City, UT 84124-1216
Phone (801) 262-3441
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04946 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 156786 1205 | UT | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962400580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1151 E 3900 S",
"address_2": "# B150",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241216",
"telephone_number": "801-262-3441",
"fax_number": "801-269-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1151 E 3900 S",
"address_2": "# B150",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241216",
"telephone_number": "801-262-3441",
"fax_number": "801-269-9005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSTEIN",
"first_name": "MICHAEL",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "UT",
"license": "156786 1205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04946",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.