EMILY ANN GOODMAN (MD) – Student in an Organized Health Care Education/Training Program, NPI 1912401308
Student in an Organized Health Care Education/Training Program
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Profile Insights
NPPES metrics only — not quality of care.
240 VASCULAR SURGERY in IL
Provider Addresses for EMILY ANN GOODMAN (MD)
5841 S. MARYLAND AVE. M/C 6040
CHICAGO, IL 606372401
Phone: (773) 702-1860
Fax: (773) 926-0732
Type: Location
Montefiore Medical Center West Campus Moses Division Hospital, 111, East 210th Street, The Bronx, Bronx County, New York, 10467, United States
BRONX, NY 104672401
Phone:
Type: Mailing
5177 McCarty Ln
Lafayette, IN 479058764
Phone: (765) 448-8000
Type: Location
180 HARVESTER DR. STE 110
BURR RIDGE, IL 605276686
Phone: (773) 702-1150
Type: Mailing
250 N SHADELAND AVE
INDIANAPOLIS, IN 462194959
Phone:
Type: Mailing
1701 N Senate Blvd
Indianapolis, IN 462021239
Phone: (888) 484-3258
Type: Location
5841 S. Maryland Ave. M/C 6040
Chicago, IL 606372401
Phone: (773) 702-1860
Fax: (773) 926-0732
Type: Location
5177 MCCARTY LN
LAFAYETTE, IN 479058764
Phone: (765) 448-8000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 68 Open Payments records for all available years, with a total value of $14,418.
Total Amount is formed as General ($14,418) + Research ($0) + Ownership ($0) = $14,418.
Last reported payment date: 2024-12-31 • Largest payer in this snapshot: Medtronic, Inc. ($9,874).
Total Amount
$14,418
General + Research + Ownership
Payments
68
Total payment records
General Amount
$14,418
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $9,874 |
| W. L. Gore & Associates, Inc. | $2,136 |
| Silk Road Medical, Inc. | $1,762 |
| Shockwave Medical, Inc | $190 |
| Penumbra, Inc. | $185 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-08-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250819002671 | I | Vascular Surgery | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60637)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IN | |
| - | IN | |
| - | KY | |
| Physician Assistant | IN | |
| Physician Assistant | MI | |
| Internal Medicine | IN | |
| Anesthesiology, Pain Management | TN | |
| Internal Medicine, Hospitalist | IN | |
| U R O L O G Y | NC | |
| Nurse Practitioner | IN |
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