NPIMap

Individual provider Active NPI

Robert L Goddard Jr., MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bloomington, IN
National Provider Identifier
1982658886
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
01062280A Issued in IN
Practice address
817 W Rosewood Dr
Bloomington, IN 47404-1849
Phone
(812) 929-2952
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 01062280A IN Primary

Addresses

Primary practice location

817 W Rosewood Dr
Bloomington, IN 47404-1849

Mailing address

817 W Rosewood Dr
Bloomington, IN 47404-1849
Phone (812) 929-2952

Other identifiers 1

IdentifierTypeStateIssuer
L3661OtherTXTEXAS LICENSE

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Em-1 Medical Services, PA Past Accepting new patients
DFW 501a Corporation Past Accepting new patients
Camino Real Emergency Physicians PLLC Past Accepting new patients
Ellis Emergency Group PA Past Accepting new patients
Texas Emergency Rooms Services, PA Past Accepting new patients
Texas Em-I Medical Services, PA Past Accepting new patients

Organizations & group practices 6

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1982658886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 W ROSEWOOD DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041849",
            "telephone_number": "812-929-2952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W ROSEWOOD DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041849",
            "telephone_number": "812-929-2952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODDARD",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2023-03-07",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IN",
            "license": "01062280A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS LICENSE",
            "identifier": "L3661",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.