Active NPI
Paul Goetz
- Clinical Social Worker
- Racine, WI
National Provider Identifier
1992823405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7240
- Practice address
- 1320 Wisconsin Ave
Racine, WI 53403-1978 - Phone
- (262) 687-2380
- NPI assigned
- Mar 26, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7240 | WI | Primary |
Addresses
Primary practice location
1320 Wisconsin Ave
Racine, WI 53403-1978
Mailing address
1320 Wisconsin Ave
Racine, WI 53403-1978
Phone (262) 687-2380
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11013500 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7240 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1992823405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 WISCONSIN AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534031978",
"telephone_number": "262-687-2380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1320 WISCONSIN AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534031978",
"telephone_number": "262-687-2380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZ",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7240",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11013500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.