PROVIDENT HEALTH SERVICES, INC. (NPI# 1346301546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346301546 |
| Entity Type | Organization |
| Organization Name | PROVIDENT HEALTH SERVICES, INC. |
| Other Organization Name | LLOYD S. GOODMAN, MD, P.C. |
| Practice Address |
4700 Waters Ave Heart and Vascular Building Savannah GA 31404-6220 |
| Mailing Address |
Po Box 933213 Atlanta GA 31193-3213 |
| Practice Telephone | 9123508222 |
| Practice Fax Number | 9123508686 |
| Mailing Telephone | 9123508222 |
| Mailing Fax Number | 9123508686 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-11-12 |
| Authorized Official Name | ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Telephone | 9123509335 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE GROUP | DA3772 | 01 | |
| SC | GPA893 | 05 |
| Other Name | Type Code |
|---|---|
| Lloyd S. Goodman, MD, P.C. | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366519530 | Provident Health Services, Inc. | Surgery | 7 Mallet Way, Bluffton, SC 29910-6064 | 2006-11-30 |
| 1225199383 | Provident Health Services, Inc. | Surgery | 4700 Waters Ave, Savannah, GA 31404-6220 | 2006-12-13 |
| 1740341783 | Provident Health Services, Inc. | Family Medicine | 4700 Waters Ave, Memorial Health Hospitalists, Savannah, GA 31404-6220 | 2006-12-13 |
| 1679634612 | Provident Health Services, Inc. | Medical Genetics | 4700 Waters Ave, Savannah, GA 31404-6220 | 2006-12-13 |
| 1700947900 | Provident Health Services, Inc. | Internal Medicine | 1101 Lexington Ave, Savannah, GA 31404-5502 | 2006-12-12 |
| 1093737041 | Provident Health Services, Inc. | Family Medicine | 4700 Waters Ave, Memorial Health Hospitalists, Savannah, GA 31404-6220 | 2006-07-25 |
| Street Address |
4700 WATERS AVE HEART AND VASCULAR BUILDING |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404-6220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023012010 | Peter M Britt | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2005-06-08 |
| 1255938288 | Mckenna Maria Valencia | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-10-02 |
| 1184239451 | Avery Thomas Helms | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-09-13 |
| 1619580800 | Matthew Shannon | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-26 |
| 1679184840 | Anna Tincher | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-12 |
| 1669083168 | Christie Vernon Klinginsmith | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-10 |
| 1396355004 | Noah Radjenovic | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-06 |
| 1558987115 | Alyssa Nadji | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-19 |
| 1952926065 | Mary Helen Ondriezek | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-15 |
| 1326661463 | Danielle Marie Carroll | Pharmacist | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780673921 | Randy Kyle Bottner | Internal Medicine | 6301 Abercorn St, Savannah, GA 31405-5701 | 2005-10-20 |
| 1245224948 | Cardio-analysis Inc | Internal Medicine | 52 Runabout Ln, Savannah, GA 31410-1638 | 2005-09-08 |
| 1245694496 | Sj Sc Cardiology LLC | Internal Medicine | 1326 Eisenhower Dr, Bldg 2, Savannah, GA 31406-3928 | 2016-04-13 |
| 1003298688 | Memorial Savannah Cardiology | Internal Medicine | 6301 Abercorn St, Savannah, GA 31405-5701 | 2015-06-19 |
| 1437530144 | Memorial Cardiovascular Consultants LLC | Internal Medicine | 4700 Waters Ave Ste 400, Savannah, GA 31404-6220 | 2015-06-18 |
| 1619216058 | St. Joseph's Cardiology Group, LLC | Internal Medicine | 11700 Mercy Blvd., Plaza D #6, Savannah, GA 31419 | 2013-02-05 |
| 1598058703 | Akinniran Adedamola Abisogun | Internal Medicine | 1326 Eisenhower Dr Bldg 2, Savannah, GA 31406-3928 | 2011-05-20 |
| 1750607222 | Gunkel Cardiology Group, LLC | Internal Medicine | 11702 Mercy Blvd, Suite 2d, Savannah, GA 31419-1750 | 2010-04-08 |
| 1740514280 | Steven Roth | Internal Medicine | 310 Eisenhower Dr, Suite 5, Savannah, GA 31406-2632 | 2009-10-01 |
| 1518102219 | William Alexander Crosland | Internal Medicine | 11700 Mercy Blvd, Plaza D #6, Savannah, GA 31419 | 2008-12-09 |
| Find all providers in SAVANNAH | ||||
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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.