DR. MARK QUINCY GOODMAN (NPI# 1609018860) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609018860 |
| Entity Type | Individual |
| Full Name | DR. MARK QUINCY GOODMAN |
| Credential | M.D. |
| Practice Address |
1253 Nw Canal Blvd Redmond OR 97756-1334 |
| Mailing Address |
1303 Ne Cushing Dr Ste 100 Bend OR 97701 |
| Practice Telephone | 5415488131 |
| Practice Fax Number | 5415266608 |
| Mailing Telephone | 5419081217 |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2020-04-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | MD160709 | OR | Allopathic & Osteopathic Physicians |
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
MD160709 | OR | Allopathic & Osteopathic Physicians |
| N | 207PS0010X |
Emergency Medicine Specialization: Sports Medicine |
MD160709 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI | 1609018860 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1303 Ne Cushing Dr Ste 100, Bend, OR 977013887 | 5413882333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215148127 | Mark Norman Goodman | Anesthesiology | 14813 Hollyhock Dr, Oklahoma City, OK 73142-1829 | 2007-05-24 |
| 1578638391 | Mark E. Goodman | Physical Therapy Assistant | 1709 N Walnut St, Hartford City, IN 47348-1359 | 2006-11-21 |
| 1851307813 | Mark Wesley Goodman | Dentist | 801 E Tamarack Rd, Altus, OK 73521-1231 | 2006-07-31 |
| 1629005780 | Mark Goodman | Pediatrics | 3200 Long Beach Blvd, Long Beach, CA 90807-5062 | 2006-06-26 |
| 1629039854 | Mark David Goodman | Psychologist | 125 W. 2nd Avenue, Suite E, Hutchinson, KS 67501-5300 | 2006-03-29 |
| 1518463959 | Mark Goodman | Counselor | 212 E Monument St, Colorado Springs, CO 80903-1004 | 2018-04-04 |
| 1801328455 | Mark Ariel Goodman | Student in an Organized Health Care Education/Training Program | 4802 10th Ave, Brooklyn, NY 11219 | 2017-04-03 |
| 1609223908 | Mark Brandon Goodman | Student in an Organized Health Care Education/Training Program | 101 Manning Dr, Chapel Hill, NC 27514 | 2016-05-17 |
| 1093158354 | Mark Jeffrey Goodman | Counselor | 210 W Galer St, Seattle, WA 98119-3332 | 2013-04-16 |
| 1568749687 | Mark Goodman | Counselor | 929 Sw Simpson Ave, Bend, OR 97702-3599 | 2011-11-03 |
| Street Address |
1253 NW CANAL BLVD |
| City | REDMOND |
| State | OR |
| Zip Code | 97756-1334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051713 | Colleen Anastasia O'sullivan | Physician Assistant | 1253 Nw Canal Blvd, Redmond, OR 97708 | 2005-05-31 |
| 1164068938 | St. Charles Health System, Inc. | Medicare Defined Swing Bed Unit | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2019-11-26 |
| 1568931343 | Cep America - Neurology PC | Psychiatry & Neurology | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2018-11-21 |
| 1427542935 | Lauren Habel | Nurse Practitioner | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2018-06-18 |
| 1124576756 | Jonelle Lynn Smith I | Pharmacist | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2016-09-12 |
| 1730544552 | Elke Jacobsen | Physician Assistant | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2015-12-21 |
| 1922488063 | Katherine Luehrs | Physician Assistant | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2015-06-03 |
| 1043606148 | Mindy Lipsitz | Emergency Medicine | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2015-04-15 |
| 1932591963 | Bryce Campbell | Physician Assistant | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2015-02-27 |
| 1750787115 | Community Pharmacy Redmond | Pharmacy | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2014-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679083349 | Vicki Rae Morris | Foster Care Agency | 3585 Sw 35th St., Redmond, OR 97756 | 2017-10-06 |
| 1275066417 | Norco, Inc | Durable Medical Equipment & Medical Supplies | 655 Nw Jackpine Ave, Redmond, OR 97756 | 2017-04-05 |
| 1750778015 | Kelly Gobler | Occupational Therapy Assistant | 3000 Sw 32nd Street, The Heights Assisted Living, Redmond, OR 97756 | 2015-04-23 |
| 1912303934 | Andrea Adams | Pharmacist | 944 Sw Veterans Way, Redmond, OR 97756 | 2014-11-18 |
| 1649670365 | Advantage Dental Clinics LLC | Dentist | 442 Sw Umatilla Ave., Suite 200, Redmond, OR 97756 | 2014-08-29 |
| 1760891832 | Elizabeth Mae Smith | Counselor | 2659 Sw 4th St Ste 102, Redmond, OR 97756 | 2014-08-04 |
| 1700296837 | Heather A Ahlf | Physician Assistant | 1245 Nw Canal Blvd, Redmond, OR 97756 | 2014-04-29 |
| 1306289277 | Asa Racquel Aramburo | Social Worker | 203 Sw 8th St., Redmond, OR 97756 | 2013-04-10 |
| 1427396969 | Alison Elizabeth Jackson | Pharmacist | 944 Sw 9th Street, Redmond, OR 97756 | 2013-01-17 |
| 1083964449 | Julie C Plachta | Mechanotherapist | 654 Nw 4th Street, Redmond, OR 97756 | 2012-09-13 |
| Find all providers in zip 97756 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730330788 | Michael Patrick Mallin | Emergency Medicine | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2008-10-08 |
| 1306005053 | Andrew Fletcher Parker | Emergency Medicine | 1253 Nw Canal Blvd, Redmond, OR 97756-1334 | 2008-06-07 |
| 1013130327 | Salma F Gharib | Emergency Medicine | 2700 152nd Ave Ne, Redmond, WA 98052-5543 | 2007-04-11 |
| 1578698866 | Neil H. Waddington | Emergency Medicine | 2700 152nd Ave Ne, Redmond, WA 98052-5543 | 2007-02-23 |
| 1346393402 | John Randall Mercier | Emergency Medicine | 2700 152nd Ave Ne, Redmond, WA 98052-5543 | 2007-01-19 |
| 1255484887 | Mary C. Maxwell-young | Emergency Medicine | 2700 152nd Ave Ne, Redmond, WA 98052-5543 | 2007-01-18 |
| 1437206000 | Warren Gibbs | Emergency Medicine | 2700 152nd Ave Ne, Redmond, WA 98052-5543 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972139418 | Larry Michael Wiedenhoft | Emergency Medicine | 465 Manzanita Ave, Manzanita, OR 97130-0810 | 2020-03-17 |
| 1184829244 | Se Jung Shin Md Professional Corporation | Emergency Medicine | 13305 Nw Cornell Road, Suite C, Portland, OR 97229 | 2007-06-19 |
| 1104028059 | Annameika Eve Goldring | Emergency Medicine | 3181 S.w. Sam Jackson Park Rd., Portland, OR 97239 | 2007-06-04 |
| 1053467985 | Brian Murray Auld | Emergency Medicine | 3621 Elderberry Dr S, Salem, OR 97302-4054 | 2007-01-25 |
| 1750448981 | Carl M Melina | Emergency Medicine | 18610 Nw Cornell Road, Suite 100, Hillsboro, OR 97124-9923 | 2007-01-03 |
| 1023103546 | Michael F. Mccaskill | Emergency Medicine | 436 Timber Lane, Grants Pass, OR 97526 | 2006-10-03 |
| 1366486912 | Mark A Stefanelli | Emergency Medicine | 2647 Grand Ave, Astoria, OR 97103-3329 | 2006-06-15 |
| 1801845953 | David Ernest Magaret | Emergency Medicine | 1201 Ne Elm St, Prineville, OR 97754-1206 | 2006-05-08 |
| 1649235219 | Victoria V Harris | Emergency Medicine | 100 E. Main Street, Suite C, Medford, OR 97501-6041 | 2006-04-18 |
| 1003870536 | Brad Barlow | Emergency Medicine | 351 Sw 9th St, Ontario, OR 97914-2639 | 2006-04-13 |
| 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.