Jacqueline Goulart Berliner, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

65009 Issued in CT

Practice address

20 E Elm St
Greenwich, CT 06830-6529

Phone

(203) 764-2230

NPI assigned

Mar 23, 2011

Sex

Female

Sole proprietor

No

Specialty

Dermatology

Education

Icahn School of Medicine at Mount Sinai, 2011

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 1, 2022 through Dec 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

• Dr. Jacqueline Marie Goulart Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 19, 2021.

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1982903449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E ELM ST",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068306529",
            "telephone_number": "203-764-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E ELM ST",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068306529",
            "telephone_number": "203-764-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERLINER",
        "first_name": "JACQUELINE",
        "middle_name": "GOULART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-23",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "283512",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "65009",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "283512",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "GOULART",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michele Shoshana Bergen, D.M.D., M.D.
• Pearl Berger, LCSW
• Kiersten Lee Berggren, MD, PHD
• Clifford A Berken, M.D.
• Gregory Berlin, PH.D.
• Jonathan L Berliner, M.D.
• Maria Cristina Bernacet, LPN
• Lana Bernstein, M.D.
• Catherine Ellen Berzolla, MD
• Bestfit DME, Inc.

• All providers in Greenwich, CT
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• 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.