DR. MIRANDA ANNE GOODALE (NPI# 1003858762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003858762 |
| Entity Type | Individual |
| Full Name | DR. MIRANDA ANNE GOODALE |
| Credential | DPM |
| Practice Address |
955 W Craig Ave Brazil IN 47834-7400 |
| Practice Telephone | 8124489290 |
| Practice Fax Number | 8124489296 |
| Mailing Telephone | 8124489290 |
| Mailing Fax Number | 8124489296 |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2019-05-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
07001015A | IN | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
07001015A | IN | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BLUE CROSS BLUE SHIELD | 000000392910 | 01 |
| IN | 200825350A | 05 | |
| CIGNA | 0385202 | 01 | |
| DMERC WITH PPG | 0732240001 | 01 | |
| IN | IHN PPO NETWORK | 37278 | 01 |
| FIRSTHEALTH | 5692086 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1214 E National Ave, Suite 130, Brazil, IN 478342700 | 8124489290 | 8124489296 |
| Street Address |
955 W CRAIG AVE |
| City | BRAZIL |
| State | IN |
| Zip Code | 47834-7400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972532125 | Clay County Podiatry, LLC | Podiatrist | 955 W Craig Ave, Brazil, IN 47834-7400 | 2006-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972149763 | Stephen P Ernest | Pharmacist | Kroger Pharmacy Store 248, 100 Forest Park Plaza, Brazil, IN 47834 | 2019-11-27 |
| 1891211330 | Melissa Ann Barker | Family Medicine | 115 Murphy Ave, Suite A, Brazil, IN 47834 | 2017-08-16 |
| 1528387412 | Internal Medicine Practice, LLC | Internal Medicine | 1011 E. National Ave, Brazil, IN 47834 | 2010-05-18 |
| 1770778102 | Fcp, Inc. | Clinic/Center | 11295 Ncr 300w, Brazil, IN 47834 | 2007-09-10 |
| 1760605505 | Erin Jenelle Graves | Speech-Language Pathologist | 1841 West County Road 500 North, Brazil, IN 47834 | 2007-04-10 |
| 1568581049 | Normal Life of Indiana | Intermediate Care Facility, Mentally Retarded | 107 Villa Court #a, Brazil, IN 47834 | 2007-03-28 |
| 1255491130 | Raymond L Dennany IIi | Dentist | 21 N Washington St, Brazil, IN 47834 | 2006-12-11 |
| 1619054715 | Michael E Whitman | Chiropractor | 501 E Us Hwy 40, Brazil, IN 47834 | 2006-11-01 |
| 1275635534 | Nilah Nicole Bonham | Optometrist | 325 W National Avenue, Brazil, IN 47834 | 2006-09-05 |
| 1649387937 | John Jay Cash | Dentist | 924 South Forest Avenue, Brazil, IN 47834 | 2006-08-24 |
| Find all providers in zip 47834 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114162435 | Russell Harms Dpm PC | Podiatrist | 1214 E National Ave, Suite 130, Brazil, IN 47834-2700 | 2008-12-16 |
| 1972532125 | Clay County Podiatry, LLC | Podiatrist | 955 W Craig Ave, Brazil, IN 47834-7400 | 2006-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356853873 | Hoosier Foot & Ankle LLC | Podiatrist | 7412 Rockville Rd Ste A, Indianapolis, IN 46214-3098 | 2017-10-25 |
| 1952830499 | Britney Ann Wenig | Podiatrist | 10122 E 10th St Ste 250, Indianapolis, IN 46229-2663 | 2017-06-08 |
| 1952846776 | Veronica Alexis Kacmar-fedorchak | Podiatrist | 3215 Willowcreek Rd, Portage, IN 46368-5013 | 2017-01-03 |
| 1629529029 | Associated Surgeons and Physicians, LLC | Podiatrist | 7920 W. Jefferson Blvd., Ste. 230, Fort Wayne, IN 46804-4166 | 2016-10-20 |
| 1902359714 | Aamir Mahmood | Podiatrist | 10176 W 400 N Ste D, Michigan City, IN 46360-9009 | 2016-07-28 |
| 1437508116 | Brian K. Penrose | Podiatrist | 611 E Douglas Rd Ste 101, Mishawaka, IN 46545-1464 | 2016-06-03 |
| 1558756023 | Sarah Standish | Podiatrist | 1001 Hadley Rd Ste 105, Mooresville, IN 46158-1884 | 2015-04-01 |
| 1467872796 | William Joseph Edward Adams | Podiatrist | 1 Memorial Sq Ste 2100, Greenfield, IN 46140-1380 | 2014-04-25 |
| 1720406564 | Rachel Chhiba | Podiatrist | 9240 N Meridian St Ste 260, Indianapolis, IN 46260 | 2014-03-30 |
| 1245679802 | Ansgar Steven Olsen | Podiatrist | 360 Plaza Dr Ste B, Columbus, IN 47201-2960 | 2013-06-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.